REPOET
CO'MMISSIONEES OF HEALTH,
IKELAND,
THE EPIDEMICS
1846 TO 1850.
Presented to both Houses of Parliament by Command of Her Majesty.
DUBLIN:
PRINTED BY ALEXANDER THOM, 87, ABBEY-STREET,
FOR HER majesty’s stationery office.
18/52.
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Dublin Castle,
29th August, 1850.
Gentlemen,
The Temporary Fever Acts, under which your
duties, as Commissioners of Health, were exercised, having
expired, I have been directed by the Lord Lieutenant to tender
to you, on the part of Her Majesty’s Government, his best
thanks for the services which, in that capacity, you have ren-
dered to the community.
From the eminent professional position which you occupy in
this city, the Lord Lieutenant is fully aware that these onerous
duties must have been undertaken at considerable personal
inconvenience ; and his Excellency has desired me to assure
you that he fully appreciates the motives which induced you to
enter upon them, as well as the ability and efl&ciency with
which they have been performed.
The unusual duration of the epidemic during which you
have acted as Commissioners of Health, connected as that
epidemic was with the misery and distress caused by the failure
of the potato crop, will no doubt have enabled you to acquire
much information which may be hereafter most useful should a
similar visitation ever occur again ; and if you would be so kind
as to furnish his Excellency with a report embodying your
views and opinions upon this important and interesting subject,
such a document would, in his opinion, be most valuable, and
he would be prepared to lay it before Parliament at the com-
mencement of the next session.
I have the honor to he.
Gentlemen,
Your obedient Servant,
Wm. M. Somerville.
The Commissioners of Health,
^c. ^c. ^c.
CONTENTS.
Report,
Fever,
The result of famine, . • • • '
Hospital Accommodation— Regulations as to granting requisitions
for, ..•••••••
Rise and Progress of the Epidemic, . . . . •
Extent and Mortality of, . . • • • •
T'ype and Complications,
Small Pox,
Food, ....•••••
Peculiarity of the Potato as Food, .....
DiflSculties attendant on providing a Substitute for the Potato,
Rice ^Errors connected with its use, .....
Oatmeal and Indian Meal — Comparative Nutrition of.
Beans and Indian Com, ......
Potato Flour — Nature of,.-...-
Effect of want of variety of Food (without deficiency in quantity),
in producing Purpura or Scurvy, .....
Raw or badly-cooked Food — Observations and Circular on, .
Good Effects from using Cooked Food, ....
Connexion between scarcity of Food and Fever,
Lowered Price of Oatmeal— Good effects of,
Fever Hospital Accommodation — Difficulties connected with, .
Observations on, in event of future visitations.
Do. on attendance on Patients in their own homes.
Ventilation — Simple Plan of, .
Disinfectants — Observations on, .....
Expenses of Fever Patients, ......
Cholera, .........
Rise, Progress, and Decline of, .... .
Large proportion of Children attacked, ....
Diarrhma, or Premonitory Stage — Comparative infrequency of.
Question of Contagion of Cholera — Observations on,
Table showing the proportion of Towns in Ireland attacked by
Cholera,
Cholera Map, p.
Replies of Medical Officers on subject of Contagion, .
Recommendation as to measures in event of future visitations.
Domestic visitation — Observations on, . . . .
Page
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42
vin
CONTENTS.
APPENDIX A.
Forms, Circulars, Orders, and Eeturns under the Temporary
Fever Acts.
No. Page
1. lustnictions for the erection of Temporary Fever Wards and
Bedsteads, ........ 43
2. Plan and Section of Temporary Fever Ward, . to face p. 43
3. Drawing for an Economical Bedstead, . . to face p. 44
4. Scale of Kemuneration to Medical Officers, . . . .45
6. Circular recommending Sanitary Measures for adoption by Belief
Committees, ........ 45
6. Letters to the Belief Commissioners respecting Bations proposed for
the Destitute Poor, . . . . . . .48
7. Form for Weekly Eeport of Patients in Temporary Fever Hospital, 52
8. Form for Weekly Eeport of Diets and Stimulants ordered for
Patients in Temporary Fever Hospital, . . . .53
9. Form for Inspector’s Eeport, ...... 54
10. Do. to show the Particulars of the Cases in
the Temporary Fever Hospital, . . . . .55
11. Do. to show the Particulars of the Cases of
Persons 111 at their own Homes, . . . . .55
12. Minute of Central Board of Health respecting the amount of Eemu-
neration that they deem fit to be made to Medical Officers
appointed under the Temporary Fever Act, . . .55
13. Order for the Eegulation and Management of Temporary Fever
Hospitals, ......... 67
14. Table showing the order in which Eequisitions were issued for the
provision of Temporary Fever Hospitals and Dispensaries, . 60
15. Table showing the Number of Patients treated under the Temporary
Fever Act, in the principal Towns, . . . . .66
16. Table showing the Number of Patients treated in Temporary Fever
Hospitals, in monthly periods, . . . . .68
APPENDIX B.
Orders, Circulars, Forms, and Eeturns under the Nuisances
Removal and Diseases Prevention Act.
1. Observations of Commissioners of Health respecting Cholera, and
Instructions relative to Precautions, . . . .70
2. Directions and Regulations for Preventive Measures, . . 74
3. Qualifications of Medical Officers,. ..... 76
4. Form for Hospital Return, . . . . . .77
6. Form for Dispensary Return, ...... 78
6. Table showing the Number of Cases of Cholera reported from the
principal Towns, ....... 79
REPORT
OF
THE COMMISSIONERS OF HEALTH,
IRELAND,
ON THE EPIDEMICS
OF
184 6 TO 18 5 0.
TO HIS EXCELLENCY GEOEGE WLLLTAM EEEDEEICK EAEL OF CLAEENDON, K.G., LOED
LIEGTENANT GENEEAL AND GENEEAl GOVEENOE OF LRELAND.
May it please Your Excellency.
In compliance with the request couveyed to us in Sir William
Somerville’s letter of the 29th of August, 1850, we beg to lay
before your Excellency the followmg Report.
The failure, to a considerable extent, of the potato crop, in
the autumn of 1845, had early awakened the attention of Her
Majesty’s Government to the suffermg and distress that must
necessarily result to a population whose means would not enable
them to obtain grain food as a substitute for their ordinary
diet.
Among the consequences to be dreaded from this calamity
was a visitation of epidemic Fever, for experience had shown
that a scarcity of food in Ireland, if of any considerable duration,
had been invariably followed by an epidemic of Fever. With
the view of providmg measures to meet this apprehended
danger, the Temporaiy Fever Act, 9 Yict., cap. 6, was enacted
on the 24th March, 1846, under the provisions of which it be-
came the duty of the Commissioners of Health to issue such
requisitions for the providing of medical relief for the poor of
Ireland, suffering under Fever and other epidemic diseases, as
naight appear to be requisite.
The Summer of 1846 passed over without producing much
cause of alarm, and the applications for the intervention of the
Board havmg only amounted to seventeen, the sittings of the
Board ceased in August of that year.
B
2 Hejjort of the Commissioners of Health, Ireland,
The potato crop having again failed in 1846, the effects of
this second failui'e were severely felt in the succeeding winter, of
1846-7, when potatoes rose to seven shilhngs per cwt., the
price in 1845 havmg been only two shillmgs per cwt. Want
of employment and of food began to give rise to great suffering.
Reports of the appearance of Fever were received from various
parts of the comitry ; and the returns from the hospitals of
Duhhn beginning to show an increasing prevalence of Fever in
the cit}'^, the Earl of Bessborough, then Lord Lieutenant, re-
appointed the Board of Health in February, 1847 ; and from
that date the Board continued its sittings dailj’-, until the
termination of the parliamentar}'- session, in August, 1850.
The state of the medical institutions of Ireland was unfor-
tunately such as pecuh'arly unfitted them to afford the requu’ed
medical aid on the breaking out of the epidemic.
The county infirmaries had not provision for the accommo-
dation of fever patients. The county fever hospitals were des-
titute of sufficient funds, and dispensaries, established for the
purpose of affording only ordinary out- do or medical relief could,
of course, afford no efficient attendance on the numbers of desti-
tute persons suffering from acute contagious diseases in their
own miserable abodes — often scattered over districts several
miles in extent.
In February and March, 1847, the applications for the inter-
vention of the Board became numerous, as will be seen from
the following epitome : —
Number of applications received in each month of tlie years
1847, 1848, and 1849, for the provision of temporary hospital
accommodation.
1847.
1848.
1849.
February,
14
January,
15
January,
9
Marcli,
51
February,
18
February,
15
April, -
53
]\Iareh,
10
March,
13
May, -
5i2
April, -
15
April and )
26
June, -
22
IMay, -
21
May, f
J uly, -
60
June, -
10
June, -
10
August,
48
J uly, -
9
July, -
8
September, -
10
August,
4
August,
3
October,
8
September, -
3
September, -
1
November, -
13
October,
10
December,
12
November,
19
December,
14
1
Total,
576
Requisitions for the provision of hospital accommodation
were not comiDhed with in all cases, as in some instances it
3
On the Epidemics oflMQ to 1850.
appeared, on the necessary inquiries being made, that the
rehef demanded was not absolutely required.
In every instance in which an application was made, the
following form of inquiiy was forwarded :
application for certificate of the board of health,
Under sec. 2, of 10 Vic., cap. 22.
“ 1. Name of Electoral Division or Divisions respecting which the
application is made ; and name of Union in which comprised.
“ 2. Whether there is any, and what Hospital accommodation already
available for the district, or any Dispensary.
“ 3. District (stating the Electoral Divisions) from which such Hospital
or Dispensary relieves patients.
“ 4. Name of Medical Officer of such Hospital or Dispensary.
“ 5. If there is no Hospital available for the District, state the nearest
Hospital, and its distance.
“ 6. Extent to which Fever or other Epidemic Disease prevails in the
Electoral Division or Divisions to which the application relates ; stating,
as nearly as may be, the number of cases which are not in any Hospital.
“ 7. If it be desired to provide temporary Hospital accommodation for the
District, state the number of Beds for which the Relief Committee consider
it necessary to provide.
“ 8. And the name of the locality which it is proposed to select for the
Hospital.
“ 9. Whether a fitting house is procurable for the purpose, or whether It
is proposed to provide temporary sheds, of which Plans can be furnished
by the Board of Health.
“ 10. Has a Relief Committee been constituted under the Temporary
Relief Act, 1 0 Vic., c. 7, for the Electoral Division or Divisions to which
the application relates ?
“11. Is the application approved by the Inspector of the Union ?
“12. Population, and length and breadth in miles of District ; and
any additional observations that may be deemed necessary.
“ The Central Board of Health consider it preferable, on economical and
other grounds, that where Hospital accommodation is required for adjoin-
ing or neighbouring districts, one Hospital, placed in a central position,
should be made to serve for such districts, rather than that small separate
establishments should be provided ; and it is recommended that, where
practicable, communication should be had with the Relief Committees of
adjoining Districts, as to the amount of Hospital accommodation that may
be requisite.
Signature of Chairman of Relief Committee or Committees.
Date and Post-town.
Signature of the Inspector of the Union.
If still further inquiry or information were deemed necessary
by the Board, a Medical Inspector was then directed to in-
quire into, and report on the extent of disease in the district.
The aggregate number of apphcations from Belief Committees
and Boards of Guardians amounted to . . 576
_ The requisitions granted by the Board for the provi-
sion of hospital accommodation, amounted to . 373
The number of applications refused was . . $03
4 "Report of the Commissioners of Health, Ireland,
The dates of the requisitions for hospital or dispensary
relief may be considered as indicating, to a certain degree, the
rise and progress of the epidemic in the different localities ; and,
in accordance with this view, the requisitions issued from Feb-
iTiary, 1847, are stated in the order of their dates in the table
in the appendix (see appendix, A. No. 14).
In the principal cities and towns, Dublin, Waterford, Cork,
Limerick, Galway, and Belfast, the foUowhig was the order of
the requisitions issued : —
Dublin . . . 4th May, 1847.
Waterford
Cork
Limerick
Galway
Belfast
5th
17th
24th
29th
13 th Nov.,
In Shgo, proceedings were taken under the 48th George III.,
cap. 47 ; the Commissioners are, therefore, tmable to give any
retimn of the rise and progress of the epidemic in that tovm.
The table (see apjpendix, A. No. 15) will show the progress
of fever from July, 1847 (when weekly reports first began to be
regularly furnished to the Board), until the month of August,
1.850, when the Temporary Fever Acts expmed. From these
returns it appears that the total number of persons treated
within the above period of three years and two months in hos-
pitals, provided under requisitions of the Board of Health, was
332,462, and that of these, 34,622 died, showing a mortality of
ten two'fiths per cent, on the number of patients received into
hospitals.
The proportions of the sexes were as follows ; —
Total Number.
Number of Deatlis.
Mortality
per Gent.
Males
158,739
17,800
11]
Females
173,723
16,822
CO
An opinion has been entertamed by many that the mortality
in Fever is less among the poor lying out under temporary
sheds, in dry ditches, or in their own wretched cabins, than
among those received into hospital. This, however, is a fallacy
which has been corrected by the reports of our Inspectors, It
arose from the circumstance, that the deaths of all who die in
hospital are registered ; but there is no record of those who
perish on the road sides, or in their own abodes — the deaths that
occurred in such ckcumstances being very frequently unknown,
even among the neighbouring inhabitants, until the bodies of
those who had died were discovered by the Medical Inspectors.
On the 'E][)idemics o/’1846 to 1850. 5
The mortality of different periods and places, occasionally
differed widely from the general average mortality. On some
occasions the rate of mortality increased to 15, and even to as
high as 29 per cent. With a view of ascertaining whether such,
high rates of mortality could he traced to any particular causes,
the following Circular was issued to the Medical Officers of
hospitals wherein the mortality for the half year exceeded 15
per cent. : —
(copy cieculak.)
“ Sir — I am directed by the Central Board of Health to draw yotu' at-
tention to the half-yearly return of patients treated in the hospital at
under your care, from which it appears, that during the half-
year, ended , the mortality has been per cent, (there hav-
ing been admitted — — patients, died, , remaining). As this
rate of mortality from Fever is so much beyond the usual average in Ire-
land, the Commissioners will feel obliged for any information in your power
which may tend to account for the same.
“ I have the honor to be, Sir,
“ Your obedient Seiwant,
“ W. H. Hopper, Secretary.
“ To Medical Officer.”
The following contains an Epitome of the Answers received from Medical Officers in reference to the above Circular..
6 "Report of the Commissioners of Healthy Ireland,
The mortulity attributed to
On the 'Epidemics <y^l840 to 1850
Answers from Medical Officers — continued.
8
Rej^ort of the Commissioners of Health, Ireland,
On the Epidemics q/’1846 to 1850
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Answers from Medical Officers — continued.
10 Heport of the Commissioners of Health, Ireland,
On the Epidemics of 1846 to 1850
11
12 Reporl of the Commissioners of Health, Ireland,
With regard to the type of disease, at different periods of
the epidemic, which, with its comphcations, principally of dy-
sentery, purpura, diarrhoea, and small-pox, has been, perhaps,
unparalleled for dui’ation and severity, the following abstracts
from reports of Inspectors and Medical OjS&cers, .will afford
some useful information. It may be stated in general terms,
that the malignity of the disease, and of its complications,
seemed mainly to have depended on the lowered state of con-
stitutional strength induced by famine ; —
PROVINCE OP MUNSTER.
County CorTc, Bandon Union, 18th March, 1847 (Dr. Stephens). —
“ The fever is of a low typhoid chai’acter, and though not fatal, still con-
valescence is slow.”
Waterford Union, Waterford, 23rd March, 1847 (Dr. Mackesy). —
“ Fever has been steadily on the increase since November last ; it is not of
a malignant character.’’
County Cork, Shibbereen Union, 20th April, 1847 (Dr. Goodison). —
“ Few houses can be said to be altogether free from either fever or dysentery.
A new disease appears to have arisen here, under the form of Anasar-
cous swelling of the lower extremities, without previous fever or dysen-
tery.”
Waterford Union, Waterford, 13th September, 1847 (Dr. Courtenay) —
“ The type of fever that at present prevails is the mild typhoid, with great
prostration of strength, the general duration being 1 4 days, with great ten-
dency to relapse in all cases, and these occur three or four times ; the ge-
neral determination has been to the abdominal mucous surfaces, gastro
enteritis, dysentery, &c., &c., and, in some cases, to the respiratory organs,
viz., typhoid pneumonia, pleuritis, and asthmatic bronchitis. The general
sequela, and rather an extraordinary one, is erysipelas of the face, which
has occurred frequently and severely since the 1st of February. Phleg-
monoid has occurred in some cases, but it did not prevail epidemically in
the city, nor could it be attributed to want of sufficient ventilation ; the
other sequela were enlarged parotidgland, and abcess opening at external
meatus — purpura in the young subject. Dysentery at present prevails to a
great extent, connected with, and often independent of fever.”
County Cork, Midleton Union, Midleton, 5th October, 1847 (Dr. Cour-
tenay).— “ Dysentery prevails here to a great and fatal amount, in fact it
is more to be dreaded at the present time fhan feyer.”
County Cork, Kinsale Union, Nohoval, l6th October, 1847 (Dr. Cour-
tenay).— “ The type of fever here is the simple continued, and a few cases
of exclusive typhus ; the usual duration is from five to eleven days, with
a peculiar tendency to repeated relapses — out of 250 cases, 240 relsysed.’’
County Kerry, Tralee Union, Dingle, 21st November, 1847 (Dr.
Burton). — “ The fever which prevailed was short in its dm'ation, but most
liable to relapse, no matter what means were taken to arrest it ; it has
usually been followed by dydbntety and dian-hoear. The duration was ge-
nerally from six to eight days ; it was attended with as much debility and
emaciation as if the patients had been confined to bed for weeks. The
mortality from dysentery was considerable.”
County Limerick, Kihnallock Union, Kilmallock, 30th November, 1847
13
On the Epidemics 0/1846 io 1850.
(Dr. Burton). — “ The general type of fever is low, but mild, with a few
petechial cases ; typhus in about the proportion of one to ten ; there is a
great tendency to relapse, followed by gastric irritation and debility, with
diarrhoea.”
County Tipperary, Nenagh Union, JSfenagh, 11th December, 1847
(Dr. Burton). — “ Fever here appears to be of the short relapsing type in
two-thu'ds of cases, the remainder spotted typhus ; usual duration of
attacks four, five, or six days ; head symptoms, pains in the joints, and
hands, and tops of fingers, were very common ; scarlatina occurred in a
few instances ; on an average more females than males have been attacked
in this locality ; bad or deficient food in all instances may be considered
the causes of fever of short type.”
County CorTc, Skibbereen Union, Skibbereen, 7th September, 1848 (Dr.
Hill). Variola is very prevalent in this district ; there are at present not
less than seven cases in hospital. The Medical Officer states, that during
the months of May, June, and July last, 1 1 0 cases of variola were treated
in the temporary hospital, of whom very few had been vaccinated.”
PEOVINCE OP CONNAUGHT.
County Mayo, Westport Union, Newport, 3rd May, 1847 (Dr. Daly). —
“ Fever, dysentery, and diarrhoea are greatly on the increase. The
type of the fever is not typhus, as seen in Dublin and country practice in
former years, when famine did not prevail ; but is entirely gastric, begin-
ing with vomiting, pains, headache very intense ; and, as I am told, com-
ing to a crisis in about seven days, relapsing again once or twice, from
which death occurred through mere debility or dian'hoea, caused and kept
up by bad food, principally Indian meal, supplied to them in small quan-
tities, and which they invariably swallow after only a few minutes’ boil-
ing, and sometimes cold and raw. The greatest mortality is among the
labourers, men and women, on public roads, in cold, wet, boggy hills. The
fever begins with racking pains, headache, and shivering, all which symp-
toms vanish in about two days ; they then appear free from pain, prostrate,
dozing, and sink on the fourth or fifth day — no vital power or means of re-
action appears in them.”
Galway Union, Oranmore,'~iHa May, 1847 (Dr. Daly). — “ The type of
fever is typhus, much more of it than in Mayo, where gastric fever nearly
as fatal ensued. Here the use of bad shellfish is more in vogue than in
Mayo, and this horrid diet produces typhus, and bowel complaints, anasarca
of face and limbs, &c. I have made a calculation with the aid of the priest
and doctor, and from my own observation, am satisfied, three-fourths of the
population (1,000) of the town, are now ill of such disorders.”
Roscommon Union, Roscommon, 11th October, 1847 (Dr. Freke). —
“ The type of the fever which prevailed in this district was, in far the
greater proportion of cases, of low adynamic form, general debility set in
early, and, in almost every case, petechial of a measly character occurred.
The duration was generally short, the fever usually terminating on the
seventh, ninth, or eleventh day by profuse perspiration. Kelapses were so
common as to appear characteristic of the epidemic — in several instances
they have occurred so frequently as three, or even four times in the same
individual. In many cases a deep jaundiced hue pervaded the entire sur-
face of the body, and, in several, there was considerable cerebral distur-
bauce.”
14 Report of the Commissioners of Health, Ireland,
County Leitrim, Manorliamilton Union, Manorhamilton, 13 th October,
1847 (Dr. Eoughan). — “Character of fever has been synoeha and typhus,
the latter preponderated in the proportion of four to one ; the synoeha was
seldom of longer duration than eight days, tendency to relapses about the
fifth or sixth day of convalescence.
“ A great number of patients, when convalescent for a fortnight, were
attacked by typhus fever.
“ The typhoid form was complicated with a red measly rash in almost
every case. The head was the particular organ engaged.’’
Sligo Union, Gollooney, 20th November, 1847 (Dr. Freke) “Two
types of fever (I am informed by Dr. Armstrong) have prevailed in this
district, one was a mild inflammatory character, the ordinary duration of
which was from eight to twelve days, and was usually followed by a re-
lapse ; the abdominal mucous membrane was chiefly engaged, and the most
common sequela were anasarca and general debility, with loss of appetite.
The second form of fever was of a typhoid character, was much less general
than the other, continued its usual course, was not subject to relapses, was
frequently complicated with cerebral affections, as also with affections of
the chest and abdomen, and demanded stimulating treatment. The other
diseases prevalent with fever were dysentery and diarrhoea.”
PROVINCE OF LEINSTER:
County WicJdow, Rathdrum Union, Wicklow, 1st September, 1847
(Dr. Courtenay). — “ The fever is of a mixed nature, with several cases of
maculce, the determination usually to the respiratory organs, also in several
cases gastritis — sequela in some cases, viz., an attack of small-pox, swelling
of the glands, particularly the paroted. Out of one hundred cases, eighty-
five relapses.”
County Wexford, Enniscorthy Union, Killegney, 7th September, 1847
(Dr. Courtenay). — “ The fever is of a gastric character, going on into gastro
interitis, duration from five to fourteen days, and, in most cases, a deter-
mination to the abdominal mucous surfaces ; in a few cases the chest was
the seat of determination. The tendency to repeated relapses is one of the
moat peculiar features of this epidemic ; in every case there were relapses.
“ Purpura has occurred as a sequela in a great number of young pa-
tients ; but dysentery has been, as a general rule, the sequela in all
cases.’’
County Meath, Trim Union, Trim, 24th September, 1847 (Doctor
Freke). — “The following is a condensation of what I have been enabled to
collect from Dr. Lamprey, with regard to the character of the disease : —
“ He informs me, that he has observed four distinct types of fever to
occur in the present epidemic. The first and most numerous are cases of
simple continued, and average fifty-five per cent. ; the period of the dis-
ease generally lasts nine days, without any marked complication, nor at-
tended with any sequela ; great tendency to relapse, which has occurred
in nearly all cases under treatment.
“ The type of the order of fever observed by Dr. Lamprey to be second
in frequency is typhoid, and of 21 days duration, and is liable to relapse;
it has occurred in the ratio of twenty-three per cent.
“ The third kind of this fever, which has received the name of yellow
fever, is characterised by the jaundiced appeai-ance of the skin, gastric and
15
On the Eindemics of 1846 to 1850.
hepatic symptoms, accompanied by severe head complications, and attended
with great perspirations. This type occurs at a ratio of eighteen per cent.
“ The fourth type observed by Dr. Lamprey is stated to be the rarest,
and to be pure typhus, attended with an ecanthematous eruption and dothi-
nuteric symptoms. These cases have occurred only in a ratio of four per
King's County, Tullamore Union, Tullamore, 21st December, 1847
(Dr. Burton). — “ In this district the ordinary fever is spotted typhus, occur-
ring in proportion of five out of seven, and appearing even in the youngest
children; duration of attack, twenty-two days.
“ A few cases of a mild ephemeral fever, enduring about seven days ;
complications generally of head, abdomen, and chest. Incidental diseases—
dysentery, scarlatina, measles, jaundice, purpura.”
County Kildare, Ailiy Union, Ballylinan, 4th January, 1848 (Doctor
Burton). — “ The type of fever was a kind of typhoid, subject to remissions ;
the average duration of attacks about five days. In one- fourth of the
cases spotted fever occurred, averaging twenty-one days.
“ Incidental diseases were chiefly dysentery, purpura, and a great deal
of scurvy, with some cases of yellow fever, the symptoms of which were
great irritability of stomach, prostration of strength, tar-like stools, blue ex-
tremities, and loss of heat — in these cases stimulants had little or no effect.
These cases were generally fatal.”
County Longford, Granard Union, Granard, 27th May, 1848 (Doctor
Courtenay). — “ The type of fever prevailing here is of a typhoid character,
in fact I have never seen so many cases of a bad maculated character as
in this hospital ; the duration is from fourteen to twenty-one days, usually
complicated with dysentery, the determination being, in most cases, to the
alimentary mucous surface ; no marked sequela, but a very great tendency to
relapse.”
PEOVINCE OF ULSTEE.
County Armagh, Lurgan Union, Portadown, 29th September, 1847
(Dr. Roughan). — “ The number of patients in hospital is 268, of these
there are at present only four cases of maculated typhus fever ; the fever
generally ends about the 11th day, and then, in broken constitutions, ge-
nerally followed either by dysentery or anasarca, or both combined ; most
all patients relapsed on the fifth or sixth day of convalescence into a fever
of shorter duration than the original one. No cases of purpura occurred in
the hospital — several in the dispensary practice ; six cases of small pox
were admitted.”
Counties Antrim and Down, Lisburn Union, Ilillsborough, 1st October,
1847 (Dr Roughan) — “Two forms of fever have been observed in this
hospital since its commencement, viz., simple inflammatory fever, and
typhus, with a petechial eruption ; the former predominated, and was of a
very mild character, its duration being from eight to fourteen days ; vomit-
ing caused much torment to the patients at the beginning — this symptom
was always accompanied by tenderness in the epigastric region, much in-
creased by pressure; relapse occurred in almost every case suffering under
this form of disease.”
County Tyrone, Omagh Union, Dromore, 27th October, 1847 (Dr.
Roughan). — “ Typhus was the character in four-fifths of the fever ad-
mitted, all cases accompanied either by petechise or maculoe, the latter more
IS Rei^ort of the Commissioners of Health, Ireland,
frequent, in the form of large purple spots scattered over the body, arms,
and legs, appearing about the fifth day of the fever, and disappearing about
the tenth or twelfth ; in many cases those spots were followed by an erup-
tion, somewhat like purpura.”
County Cavan, Bailiehorough Union, Kingscourt, 30th June, 1848
(Dr. Hill) — “ The fever now prevalent is of a mild type, its prominent
symptoms being headache, nausea, or vomiting, and acute pains in the
limbs, the ordinary duration is from nine to eleven days ; but the tendency
to relapse is so strong, that very few escape without one or more secondary
attacks, and the convalescence is generally tedious; maculated cases are
now seldom seen.”
We abstain from entering into any observations on the de-
tails of treatment for the following reasons : —
To render deductions as to treatment satisfactory, it would
be necessary to be assured that the cases compared should be
of lilce character and type — a condition which it would be im-
possible to attain, as the cases in different institutions, m dif-
ferent parts of the kingdom, must be subject to constantly
distiu’biug causes, arising from varieties in locahty, constitution,
diet, previous habits and employments, &c., and even from hos-
pital arrangements. Satisfactory results as to varied modes
of treatment of most diseases, can only be arrived at by prac-
titioners who, deducing their results from instances under then’
own immediate observation, can thus assure themselves that
their observations are made on cases of the same natine.
Moreover, details of medical treatment being matters pmely
professional, would not, perhaps, properly come within the
scope of this report.
It is, perhaps, scarcely necessary to observe, that this epi-
demic, like all former similar visitations, assumed a contagious
character, and that the mortality was great among the upper
classes — Clergymen, members of Eehef Committees, Inspec-
tors, and Medical Officers, whose duty, or whose benevolence,
exposed them to contagion. Of 473 Medical Officers appohited
under the Temporary Fever Acts, 36 died dm’ing the preva-
lence of the epidemic.
Emigrants from Ireland carried the disease to Liverpool, and
to several ports in North America. Fever thus hnported into
Canada was, according to reports which have already been
pubhshed on the subject by the local authorities in that country,
exceedingly fatal.
We do not deem it necessaiy to give any meteorological
tables for the period of the epidemic, as those already pub-
lished in the various scientific journals do not show that there
was any remarkable deviation from the ordinary climate of the
country during its prevalence.
SMALL-POX.
Small-pox prevailed to a considerable degree during the year
1849. In the month of December in that year, a circular was
17
On the epidemics of 1846 to 1850.
addressed to all the Medical Officers einploj'^ed under the 1 em-
porai’y Fever Acts, requesting information as to the number
and nature of the cases which came under their notice within
the 3mar.
The returns show a total of 7,319 cases for the year 1849 ;
hut tliis scarcely approximates to the real number, for (as ob-
served by some of the Medical Officers) — “ relief is not applied
for except in very dangerous cases, and the number stated is
hut a small proportion of the cases that were in the district.
Again — “ it is only where there is immediate danger of life
that a medical man is called in, lest he might be obliged to
j)rosecute the inoculator. The people” (in the provinces) “ are
generally steadfast in the old practice of inocidation of small-
J)OX.”
The increased prevalence of small-pox was, no doubt, attri-
butable, in some degree, to the continuance of the practice of
inoculation, hut more to the want of an efficient system of
vaccination ; the Guardians, in many instances, having omitted
to make contracts, or having allowed vaccination contracts to
expire, thus leaving the poor to the alternative of inoculation
as their only protection against small-pox. But as these
circumstances did not peculiarly belong to any one year, they
do not appear to be in themselves sufficient to account for the
increased prevalence of small-pox at this particular time, and
still less for its peculiarly malignant character.
It was not in the power of the Medical Officers to give ac-
curate returns of the mortality from small-pox ; hut their ac-
counts nearl}" all agree in representing the disease as having
generally presented a confluent character and malignant tjq)e.
The following are returns from hospitals in Dublin : —
Fever Hospital and House of Recovery, Cork- street.
Statement of the number of cases of Small-Pox received
into Hospital during the past eleven years, distinguishing
the number of Deaths, and whether Vaccinated or not
Vaccinated.
Yenrs.
Ailiuittod.
Vaccinnted.
Not Vaccinatod.
Died.
]H.K)
28
II
10
o
18U
4
1
:)
IHia
rw
]:l
20
r>
lHi:i
12
2
10
o
1 SI 1
1
1
1
181.'^
IK)
10
70
1!)
IHIO
17
2
10
;i
1817
10
1
0
o
1818
28
0
2!)
(]
1840
100
10
80
.10
1800
47
0
38
10
18
Report of the Commissioners of Health, Ireland,
Hardwick Fever Hospital.
StatGuiGnt of tliG iiumbGr of cases of Small-Pox recGived into
Ilospital during the past eleven years.
Years.
Admitted.
Vaccinated.
Not Vaccinated.
1840
1841
1
__
1843
23
_
1843
17
_
' 1844
6
_
1845
70
_
_
1840
39
_
_
1847
20
_
1848
47
_
1849
lOG
1850
99
38
01
Died.
5
4
le
0
8
9
40
31
No accoimt of the disease kept prior to 9th September, 1841.
The particulars of Vaccination commenced to be taken in
the month of February, 1850.
ROOD.
The failure of the potato crop fell with pecuhar severity on
the laboring class of Ireland — the peasantry generally dependmg
for their food not on money-wages, but on jjotatoes raised by
their own labor — for which there was otherwise little employ-
ment at certain seasons of the year. Hence, on the failure of
the potato crop, the difficult jiroblem presented itself, of not
only furnislung food to the poor at the lowest price, but of pro-
viding them with employment, in order to enable them to pur-
chase it. The reports of the Eehef and Poor Law Commis-
sioners show the gigantic efforts made to meet those difficulties.
We have, however, onl}' to deal with the effects of the failure
of the potato crop in a dietetic point of view, and its bearing on
the production of fever \ and we are of opinion that even had
a full supply of grain food been obtainable instead of the
potato, there would still have followed a considerable amount
of disease. The following are briefly the grounds on which we
advance this opinion : —
Chemical investigation has shown that the potato has a pe-
culiarity distinguishing it from almost all other vegetables and
kinds of grain used as human food. Although affording an in-
ferior nutriment in proportion to the bulk consumed, from its
consisting of about three-fourths water, it nevertheless con-
tains in its composition nearly all those elements of nutrition
that exist separately in most other vegetables and grain, and
are, therefore, only to be obtained from most other articles of
food by combining together diflerent kinds. Hence, the potato
can be used singly for support and nutrition ; while in using
other vegetable products there is required a combination of va-
19
On the Epide77iics of 184G to 1850,
lious kinds to furnish the varied elements that are necessary for
the growth and support of the human body. In ignorance of this,
rich and poor alike fell into error, in attempting to substitute
some one article or other of food, as a sufficient equivalent in
itself for the potato. The poor, forced by necessity, attempted
to support themselves on whatever grain they could obtain ; the
rich, moved, by the best motives, made the greatest exertion
to substitute for the potato some other vegetable, such as they
wei’e led to believe furnished the staple food ot the people of
other countries. Eice was one of the main articles which pre-
sented itself ; and the popular, but erroneous idea, that it fur-
nished the sole article of food for whole nations, led to an at-
tempt to make it a substitute for the potato. Eice alo7ie, how-
ever, is not anywhere the sole support of any portion of the
human race. Experience or instinct has taught those who use
it as a chief article of food that, of itself it is not adequate to
support life, and hence, there is always consumed with it in
those countries where it is generally used, oil, dal, or some
other vegetable, seed or grain, meat or fish, in order to add to
the rice such of the elements of nutrition as it does not in
itself contain. Thus, even if a full supplj’' of grain food had
been obtainable, the great bulk of the people would have con-
sumed it, ignorant of the need of those combinations that are
requisite in its use, and disease, to a considerable extent, would
have resulted, until experience and information had corrected
the error. A frequent mistake connected with the introduction
of rice was the supposition that the hulk acquired by boil-
ing afforded an indication of tbe quantity of nutriment con-
tained in such bulk. With the view of correcting this error,
we issued several communications on the use of rice and other
articles of food, and the following extracts from some of those
communications will explain our views on those points : —
“ The Board of Health cannot hesitate to assure the Relief Commis-
sioners, that rice, instead of being superior, is much inferior to Indian corn
meal in nutritious qualities.
“ It is true that rice, by steeping and boiling, may be made to furnish a
larger bulk of apparently solid food than will be furnished by an equal
quantity of Indian corn, and hence has probably arisen the supposition of
its being more nutritious ; but the bulk thus obtained is deceptive as to
the quantity of nutriment ailorded. Rice contains about eighty-five parts
in every 100 of starch ; a given quantity of it will, by steeping and boil-
ing, absorb a very large proportion of water, and will swell into a large and
apparently firm mass ; but this mass will contain a very small proportionate
quantity of nutriment. A very simple experiment will satisfactorily illus-
trate this one ounce of cominou starch boiled in the ordinary way will form,
with a pint of water, a firm mass, which, from its apparent consistency, will
seem to be good substantial food ; but the bulk thus formed, it is obvious
contains very little nutriment. In like manner of rice— one pound of it
may be made to form, with water, a starchy mass of five or six pounds
weight ; but the produce, as in the experiment of the starch, is bulk, with-
out equivalent nutriment. '1 he Board of Health are anxious that their ob-
20 Report of the Commissioners of Health, Ireland,
servations on this subject should be clearly understood and widely disse-
minated, as the error is very generally prevalent of supposing, that in
using rice or other similar substances, an amount of nutriment is afforded
equal to the bulk gained. The Board of Health do not at all object to the
use of rice as food ; on the contrary, they highly approve of it, provided it
be furnished in sufficient quantity.
“ The Board of Health are fully aware how necessary, and how pressing,
at the present time, is the exercise of the strictest economy ; but they are
also convinced, that if the use of a diet be permitted, containing too large
a proportion of fluid, deficient in the due quantity of nutritious elements,
and deriving its solidity principally from the presence of starch, the result
must necessarily be, in those living on it, debility of constitution with con-
sequent inability to resist disease, and ultimately, increased expenditure in
the cost of relief, instead of saving.
“ For these reasons, the Board of Health deem it important that the
principle laid down in their previous communication of 11th May, should
be strictly adhered to, viz. : — that rations should be given out cooked, and
in as solid form as possible, and that they should be estimated, not by
the bulk when cooked, but by the rule that each cooked ration should con-
tain the equivalent of one pound of raw meal, the quantity originally sanc-
tioned by the Belief Commissioners and the Boai’d of Health.”
It was also frequently proposed by Relief Committees and
Boards of Guardians, to lessen the rations when oatmeal was
substituted for Indian meal, the former being erroneously sup-
posed to be more nutritive than Indian meal. The two grains,
however, differ so little in nutritive qualities, that the Board
decided that rations, whether of oatmeal or Indian meal, should
be of the same weight.
Similar difficulties to some of those noticed in respect to the
use of rice, existed in the attempts to substitute either beans
or Indian corn as the sole substitute for the potatoes, viz.,
that neither of those articles of itself can be used like the po-
tato as the sole article of support. Another error at the time
of the failure of the potato, and the most generally diffused, was
in the attempt to substitute for the potato itself what was very
generally, but erroneously, called “ potato floui’,” which was
obtained in large quantities from rotted potatoes. This so
called “ potato flour” was, however, not flour in the i^roper
sense of the word as applied to wheat flour, for it did not con-
tain the elements of the potato, but consisted wholl}' of
starch or fecula, and was quite unfitted to support health or
even life for any considerable length of time. It was as errone-
ous to consider tliis starch as equivalent to the potato, as it
would be to consider wheaten starch as equivalent to wheaten
floiir.
Even among tradesmen and laborers on railways, who
earned sufficient wages to buy good food, tlie result of the loss
of the potato was seen in tlie production of scurvy or purpura,
in consequence of tlieir being unaware that variety of food was
necessary to form healthy blood. Their diet was most fre-
quently white bread and cofi’ee, with sometimes animal food
21
On the Epidemics <^184G to 1850.
but yet, tliese articles not containing sufficient variety of ele-
ments, scurvy was the result.
The same effect was seen in some public schools from similar
causes. The following is an extract from a circular of the
Boai’d of Health of the 2ist June, 1847, on tliis subject:—
“While on the subject of diet, the Board of Health deem it of impor-
tance, through the medium of the Relief Commissioners, to draw the atten-
tion of relief committees, and of the people generally, to the fact, that a
form of disease, now very prevalent among the people, resembling in many
particulars sea scurvy, is connected with or dependent on a defective nutri-
tion, arising not from deficiency of quantity, hut from deficiency of quality
or variety in the food. The potato, although not containing a large pro-
portion of nutriment, is remarkable as containing within itself all the varied
elements necessary for forming healthy blood — no one of the substitutes for
it, with the exception of oatmeal, possesses this remarkable property ; and
hence, the use of more than one article of food is necessary, in order to
secure a sufficient supply of the varied elements of nutrition, and thus to
obviate the form of disease referred to.
“ With this principle in view, the Board of Health, as the season of the
year now gives facilities for it, strongly recommend the admixture of onions,
leeks, scallions, or shallots, in cooked meal rations or stirabout, which will
both act as condiments, and will also furnish some of the elements of nu-
trition essential for forming healthy blood. Onions are so rich in nutritive
qualities, that, as a mere article of food, one ounce and a half may be con-
sidered as equivalent to about one ounce of meal. On every opportunity,
the importance to health of using vegetables, such as carrots, parsnips,
turnips, and cabbage, along with meal, should be impressed upon the
people.
“ It may not, perhaps, be out of place in these observations, to make
the people generally acquainted with the high nutritive qualities of beans
and peas, which, weight for weight, contain from ten to twelve times as
much nutriment as potatoes. In those countries where rice is very exten-
sively used as the food of the people, experience has taught them that rice
by itself has low nutritive qualities ; but that the deficiency can be sup-
plied by adding about two ounces of beans, peas, or lentils, to each pound
of rice. It must, however, be remembered, that with beans or peas, some
other vegetable food must be used, as, although possessing in a high de-
gree some of the most important elements of nutrition, they nevertheless
do not contain a sufficient variety of other nutritive elements to support
the human body in health.”
Another cause that existed, adding much to the production
of diseases among the poor, was the use of raw or hadly-cooked
food.
I his engaged the earliest attention of the Commissioners.
On the loth March and 11th May, 1847, we addressed
communications to the Relief Commissioners, of which the
lollowing are extracts : —
The Board of Health, however, suggest, that in all instances where
practicable, the food should be given out in a cooked form ; as food, how-
ever good in itself,^ will, if not sufiiciently cooked, not alford its full supply
of nutriment, and it will, moreover, predispose to attacks of dysentery aud
23 liepori of the Commissioners of Health, Ireland,
diarrhoea, now so prevalent through the country. They likewise suggest
that the food given out should be varied occasionally — as for instance, on
one day, that bread rations be given ; and on another, soup and bread ; or
meal and rice porridge, with bread, &c.
“ The Board of Health now desire to draw the attention of the Relief
Commissioners to the communication from the Board of Health of the 1 0th
March, in which they recommend, that ‘ in all instances where practicable,
the food should be given out in a cooked form.’ They are now, from re-
ports which have reached them, anxious to urge on the Commissioners the
necessity of taking measures to have this recommendation acted on, with-
out exception, in all instances. The Board of Health feel it only neces-
sary to observe, that they fear, unless the principle be fully carried into
elFect, of giving out the food only in a qooked form, there will be always
both an abuse and a serious evil of another kind to contend with. The
abuse is, the sale of raw meal, for which purchasers are always to be found,
to whom even the poor requiring the food for themselves or family will
dispose of it for money, tea, or tobacco ; and the serious evil is, the con-
sumption of meal or rice, but more particularly Indian meal, in a raw or
badly cooked state, which will predispose to, and aggravate dysentery and
diarrhoea, already so prevalent through the country.’’
The Board received from all parts of the country satisfac-
tory communications of the improvement produced in the
health of the people by the issue of well-cooked food. The
following are extracts from some of the communications : —
“Those districts in which ‘eating houses’ are in full operation,
show a great improvement in the .sanitary condition of the people —
many bad cases of fever and dysentery have recovered from the use of
the food given them out of these sources of relief.”
“ Fever and dysentery are of a much milder form than hitherto,
and the deaths very few in comparison, especially in those districts
where cooked food has been adopted for any length of time.”
“ There has been a marked improvement in the health of the people
generally since relief has been administered in food, particularly
where it has been cooked. The prejudice which was strong against
cooked food at the commencement has graduall)'’ yielded ; very many
of the people admit they prefer it to meal. There can be no doubt
that it has had a marked effect in checking bowel complaints. The
districts most free from fever are those where cooked food has been
the longest in use.”
“ It is a remarkable flxct, that in those divisions where cooked food
is not used, fever and dysentery are, or have been, most rife.”
“ Three weeks ago, when fever w’as rather abounding, the Relief
Committee took up the idea of having fever sheds built ; but since
cooked food has been given to the people, fever has, under Provi-
dence, astonishingly declined.”
The connexion between the scarcity of food and the preva-
lence of fever will be seen from the following table, which gives
tlie prices of wheat, oats, oatmeal, and potatoes in the Dublin
market, in periods of quarters, for four years, conimeiicing in
1845, and terminating in 1850 : —
On the 'Epidemics <^1846 to 1850
S3
ll tl „• ^
«j in ej ® t*- l»
•°g -“S 5 S
- h
vA-'-A-' s. s
g
CO
•Joqo^oQ
^ o o o o
. CD O ^
«e M
•^tnr
^ 2 “
, ^ o
OJ M
•ludv
-a = ^ °
— o o
ej ^
•Xronuuf
^ eo o o o
. — o o •**<
«P C» ■-'
2
cb
■ioqopo
• O 50 CO
^ r— r~>
. 0> CJ o CO
«o ^ «
•-flT
eo CO o
. CO CO CO >-■
«* ^ 1-^ —
•II-KiV
o »o o o
CO 5| M S *'*
•XjTmuTJX*
t«» e» o o
, ^ o — o
CO (M r->
CO
w
•JoqojOQ
•e 2 °
. CO i-i A
«0 W ^
'tj CO W O ©
• O (M 9) CO
09 CO •-■ <-■
•nJiIy
^ ^ O O CO
. h>. o — t>.
Cq CC _« «
•ifiimtrox*
tJ -cp CO CO CO
. o M eo
«9 G-< — <-«
•aaqo^oo
'55 O © CO O
. CO ^ o o
09 w IM ^
••tinf
s. cl.
39 0
IS 0
20 0
12 0
•liJdy
'So© © ©
. © ^ -p ©
Co -S» W Cl
•.Otmuvf
*53 o o o o
• -• «-• © »s.
*0 Cl Cl
CO
•jaqoioo
'S O © © C9
•9' CO 2 2
•jfinf
'S o o o ©
. O >r> © ©
00 © M »->
•lIJ'Iv
'S O CO O ©
g 2 2 ’
•Xatinutjf
'55 o o © ©
g 2 2 «
i
M0({0)3O
'55 rt rt o o
» a e» n m
«0 Cl —•
•Xliif
'55 © © O «p
^ © Cl Cl Cl
•lIJcIv
o « « ©
. © «-■ Cl d
«0 CM ^ 0m
•.Ounu-Bf
'59 o © © ©
. © Cl ei
00 Cl mm mm
•a 2*
n . S S
s H a
g 5 S ^
24 Beport of the Commwsioners of Healthy Ireland,
It is impossible not to be struck with the coincidence be-
tween the scarcity and consequent high price of potatoes and
the prevalence of fever: —
s. d.
In 1845, potatoes averaged 2 2
In 1846,
„ 4 10
In 1847,
)>
„ 8 4
In 1848,
„ 7 0
In 1849,
))
„ 0 11
In 1850,
,, 4 4
In 1845 there was no epidemic. In 1846 the scarcity was
first felt, and fever began to show itself, and as prices still
continued to rise in the winter of 1846, and spring of 1847, the
effects of want of food were seen in an alai’ming increase of
fever, and during the years 1847 and 1848, and greater part of
1849, the prices continued so high as to deprive the poor of
their accustomed food, and notwithstanding all the long con-
tinued and benevolent exertions of Government and individuals,
an epidemic of unparalleled severity and extent continued its
ravages.
The number of patients admitted into temporary fever hos-
pitals, in
1847 was 95,890
1848 „ 110,381
1849 „ 87,135
1850 „ 39,056
The price of potatoes, although having fallen considerably
in 1850, still averaged, it will be observed, double the price of
1845 ; but the injurious efiects that would otherwise have still
followed from the continued comparative scarcity and high
price of potatoes, were counteracted to a very considerable
degree by the cheapness of oatmeal, which fell, in the autumn
of 1849, to 10.V. ^d. ]per cwt., and averaged during 1850, onl}'
10.S-. 5f/. per cwt. This was little more than double the price
of potatoes, and as oatmeal in weight for weight contains above
four times as much nutriment as potatoes, the peasantry, when-
ever they were by money-wages enabled to purchase oatmeal,
obtained at little more than double the price of potatoes, a food
that contained more than quadru]>le nutriment, which was a
benefit equivalent to a reduction of about one-half in the price
of potatoes. In the autumn of 1850, a cwt. weightof oatmeal could
be purchased for lO.s;., equivalent in nutrition to more than four
cwt. of potatoes, which would cost about 18.v. But for this
lowered price of oatmeal, it seems ceilain that the same
amount of distress and disease would have continued to prevail
in 1850 as in previous years. The people ivere not slow in
discovering, that the advantage in econoni}’^ and nutriment was
on the side of oatmeal. In a communication received from an
35
On the Epidemics <^1846 to 1850.
inteUicent Inspector under the Drainage Commissioners, he
observes — “ As to potatoes, they are quite too expensive loi
ordinary food at present (February, 1851) ; even farmers who
have large quantities of them prefer (through, however, motives
of economy only) selling them, and livmg, with them seiwants,
on oaten and Indian meal.” It has often been desired, that
the people of Ireland could he induced to tuim from the potato
to grain as their food, as tending to produce improv^nent m
their habits, and as rendermg them less liable to suffer irom
periodic famines. All attempts to effect this have hitheito
failed. However, the knowledge that they have now acquired
of the very superior nutritious qualities of oatmeal, and itspiice
continuing to bear such a relation to the cost of potatoes, a,s to
render its consumption often more economical than that of the
potato, will, it would seem to us, eventually and certainly lead
to the desired end.
HOSPITAL ARRANGEIVIENTS — VENTILATION EXPENSES OP
PATIENTS.
It has been abeady observed, that of 576 applications from
local bodies for hospital accommodation, 303 were refused, and
373 were granted; but even this number was far above what
would have been requisite if the Board of Health had been
able to carry out its views. The Board were most auxioim in
the outset, to establish hospitals only in suitable central situa-
tions, which hospitals might then, from time to time, have
been enlarged or contracted as required, and the cost of erect-
ing additional hospitals with all the expenses consequent
thereon might have been obviated. Various obstacles, how-
ever, prevented this plan from being carried out. The
amended Fever Act of April, 1847, clause 2, authorized the
Commissioners of Health to issue certificates requiring hos-
pital relief to be afforded m electoral districts ; but only ac-
cording as the necessity for it arose in each electoral district ;
the Board was thus precluded from directing hospitals to be
erected in the first instance in central situations. Even where
several electoral districts were so circumstanced that they
might have been united with great advantage for the purpose
of giving combined hospital relief, the several relief commit-
tees frequently refused to unite ; in some instances, from a de-
sire to have each a separate hospital ; in other instances, from
a reluctance to incur the expense of affording any hospital re-
lief whatever. The consequence was, that notwithstanding tho
advice avid remonstrances of the Board of Health, hospitals
were established in much greater numbers tlian would have
been sufficient, and expenses were thus incurred that might
have been avoided. In some unions, as many as ten hospitals
were erected ; in otheis, eight; and, in very manj’-, from four
to seven ; the hospitals, in some cases, not being more than
26 Report of the Commissioners of Health, Ireland,
two or three miles asunder. The had effects of this were
felt not only in the outset, by the erecthig and maintaining
of an unnecessary number of small hospitals with their se-
parate staffs, but were continued wdien the epidemic had con-
siderably declined ; for it was then often found impracticable to
reduce them in proportion to the decHne of the epidemic, as
they were frequently so inconveniently and unsuitably located,
that although there might be several hospitals in one union, no
one hospital was sufficiently central in locality to serve for
the accommodation of two or more electoral divisions ; and
thus, dining the decline of the epidemic, several small hospitals,
each burthened with a staff sufficient for a large institution,
were necessarily continued at an unavoidable expense. The ex-
perience of the late and of former epidemics shows that it is
hopeless to expect that fever, once having made its appearance
as an epidemic, can, by any sanitary precautions, be limited to
any particular district. It will, therefore, be found most eco-
nomical, should a similar visitation again take place, at once
to provide hospital accommodation in central situations — such
hospital accommodation will be available for large districts,
and can be contracted or enlarged according to necessity. The
multiplied and unnecessary expenses attendant on the main-
taining numerous small hospitals would be thus obviated.
Eepresentations were, at different times, made to us from
various Belief Committees, requestuig our sanction to propo-
sals for providing attendance on fever patients in their own
homes, and. supplying them there with medicine and nutriment.
These we always discountenanced, on the grounds that it
would be quite impossible, under any management, to treat
cases of fever with advantage to the sick, or ivith a due regal'd
to economy, in the houses of the poor, often scattered over an
extensive district ; while there was, moreover, the very serious
objection to the proposal, that the poor, ill of fever, lying with
their families in ill-ventilated cabins, would propagate and in-
definitely extend the disease. In a few instances, where the
plan was introduced by Eehef Committees, it was abandoned
as being ineffective, and yet more expensive than hospital
relief.
As in many situations in the coiuitiy, no buildings could be
procured adapted for the purpose of fever hospitals, and as it
became necessary to increase the accommodation in previously
existing hospitals, Mr. Wilkinson, Architect of the Poor I^aw
Commission, furnished the Board (in accordance with tlicir
suggestions) with plans for the construction of fever sheds and
wooden bedsteads of a very simple and economical construc-
tion, which were found fully to answer the piu'pose (see appen-
dix A, Nos. 2 and 3).
It was a matter of great importance to furnish some simple
and effective plan of ventilation for fever hospitals, and after
many trials the foUowiug has been found to answer the pur-
27
On the Epidemics of 1846 to 1850.
pose. A sheet of zinc or tin plate is punched (not drilled)
with holes one-twelfth-inch diameter, and half an inch apart —
thus prepared, it is inserted in place of a pane of glass in every
window, or every alternate window, as required, care being
taken that the side on which the hiuTS project is turned to the
weather so as to throw off the rain. Neither wire-gauze nor
perforated zinc of the ordinary kind will be found suitable, as
both permit blasts of cold air and rain to pass through them,
and the former is liable after some time to become choked with
dust. Those who have had practical experience of the import-
ance of ventilation to the sick, and of the difficulty of maintain-
ing it, will appreciate the value of a simple plan that combines
utihty with cheapness, and which cannot be interfered with by
the inmates of the hospital. In the appendix (Ap. A., No. 13)
will be found the general order of the Commissioners for the
internal regulation, attendance, and dietaries of fever hospitals.
Proposals occasionally came before us for the emplo3^ment
of various disinfecting agents, as a means of destroying conta-
gion, and thus destroying the epidemic. We did not feel our-
selves authorized to sanction any expense in such trials; ex-
perience and experiment have fully shown that chemical agents
may deodorise, but fail to disinfect, that the most fatal epidemics
are often generated and extended in what (to our senses,
and to all chemical examination) would seem to be the purest
air, and that the most offensive odours are often habitually
inhaled with impunit3^
It is also to be remembered, that none of the supposed dis-
infectants have the power of restoring oxygen to the air ; it is
evident, therefore, that disinfectant substances which deodorise,
must still leave the air, as far as regards its proi^ortion of
oxygen, as unfit for the support of animal life as before, while
the very destruction of the bad odours by any other means than
by a free cii-culation of fresh air, would rather tend to divert
attention from the only effectual purification of the wards of
the sick— viz., by the free, and constant circulation of fresh
air, in our opinion, the only effectual method of purification.
These observations, however, are by no means intended to de-
preciate the use of charcoal, chlorides of lime and zinc, and of
other deodorising siibstances for the destruction of the bad
odours arising, during the emptying of cess-pools, or during the
temporary removal of deposits from sewerage.
The financial arrangements of the fever hospitals were not
under the superintendence or control of the Board of Health,
having been managed under the 10th Victoria, cap. 22, by the
Relief Committees, and under the 11th and 12th Victoria, cap.
131, by the Poor Law Guardians. The Board of Health,
however, from returns furnished to them, made a report to
Pailiament in 1850, showing the cost of support of patients
m temporary fever hospitals in the j’’ear 1849 (Parliamentary
Paper, 442). The returns of expenditure were received froi^
28 Report of the Commissioners of Health, Ireland,
the clerks of the unions in which the hospitals were situated,
and this return shows that the average weekly cost, including
salary of Medical Officer, was 4s. per patient.
CHOLEEA.
Cholera having made its re-appearance in Europe in 1847,
and continuing to advance in 1848 towards this kingdom, your
Excellency was pleased, by an order in Council, of the 4th of
October, 1848, to direct that we should carry out the provisions
of the Nuisances Eemoval and Diseases Prevention Act, with
reference to means for the prevention, as far as possible, of the
predisposing causes of the disease, and for the medical care of
the poor who might be attacked by it.
With the view of promoting the early adoption of precau-
tionary measm’es, and of having the necessary arrangements
perfected in due time, we issued the following circular on the
1st September, 1848 (see appendix B, No. 1), previously to the
appearance of the epidemic in this country, and having care-
fully watched the progress of the disease, and deeming that the
time had at length come when it was advisable to issue the re-
quisite legal authority under our hands, in accordance with the
provisions of the act referred to, we issued, on the 7th Decem-
ber, 1848, the directions and regulations for carrying out the
provisions of the act (see appendix B., No. 2).
The following table is so arranged, from reports forwarded
to the Board, as to show the rise, progress, and decline of the
epidemic : —
SuiiMAET of Returns of the number of cases of Cholera reported to the Central Board of Health, distinguishing
the sexes, ages, premonitory symptoms, and date of the first and last case.
On the Epidemics of 1846 to 1860
29
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30 Report of the Commissioners of Health, Ireland,
The rate of mortality on the whole number of cases was
forty-two one-fifth per cent.
Tliis visitation was remarkable for the large number of chil-
dren attacked. From the returns, it appears, that of the total
number reported (45,698), the number of children attacked
under seven years of age was 4,506.
It also appears that in this epidemic the first or diarrhoea
stage of the disease was not as distinctly marked as in former
epidemics. Of the total number, 45,098 cases, 31,162, were pre-
ceded by a premonitory stage of diarrhoea, of var5'ing duration ;
while in 14,536 cases, or nearly one-third of the whole number,
the disease at once showed itself in the stage of collapse, with-
out any premonitory symptoms.
The question of the influence which contagion may be sup-
posed to exercise in the propagation of cholera is of the utmost
interest, involving as it does the subject of preventive measures.
We feel ourselves hound to state that the subject is still
enveloped in great obscurity. Differences of opinion still
exsit as to the contagious or non-contagious chai’acter of
the disease ; but the weight of evidence is decidedly in favor of
the opinion, that contagion has little, if any, influence in its
propagation. Individual cases sometimes occiu’, which would
seem to leqd distinctly to the conclusion that personal infec-
tion did occur, but it must be always remembered that persons
in connexion with the sick are equally with all others liable to
be affected by the epidemic, and it becomes a matter of impos-
sibility, under such circumstances, to determine in any given
case whether the attack has proceeded from contagious or from
epidemic influence ; but this objection does not fvpply to cases
iir which the disease has originated without previous exposui-e
to contagion. If it can be established that the disease has ap-
jieared where contagion could not originate it, and if it can also
be shown that the disease has not appeared or has not spread
in circumstances in which there was full exposure to contagion,
two points which we believe will be fully established in the fol-
lowing report, the conchxsion will then, we thuik, be satisfac-
torily established, that contagion is an element of little, if any,
influence in the spreading of the disease.
The following instance of the first appearance of the disease
in the Convict Depot, Smithfield, Dublin, appears to prove
satisfactorily that the disease may originate without the agenc}’- of
contagion ; —
Cop]j of minute of invest! r/at ion held hj Commissioners of Central Board,
of Health, on Sunday, February Hath, 1849, at Smithfield Depot for
Convicts, Dublin, to inquire into the case of John Mohan, convict,
reported to have died of Asiatic Cholera.
“John Mohan, convict, at 64, committed January 7th, 1848, never
in hospital until last illness ; taken ill Saturday, 24th February, 1849,
at 3 o’clock, P.M., with purging, cramps in abdomen and legs, rice
On the Epidemics of 1840 to 1850.
81
water vomiting, and stools, surface blue and cold, pulse almost imper-
ceptible; seen by Surgeon Rynd at half-past four o’clock; six o’clock, i
P.M., again visited — symptoms slightly alleviated. Half-past ten, p.m.,
(next visit, when Surgeon Rynd remained till twelve o’clock) — Mori-
bund; died at half-past three o’clock, a.m., 25th ; duration of iUness,
twelve hours.
“ Previously to his illness, Mohan had been under the same circum-
stances as all the other convicts ; had no intercourse whatever with
any person from without, nor with any within the walls except with
his fellow-prisoners, and with the turnkey, whose only communication
with him was unlocking the door of his cell in the morning, and lock-
ing his cell door at night. The turnkey is in perfect health.
“ No admission of prisoners since 11th January until 20th February,
when ten prisoners were admitted from King’s County, all in good
health on admission, and who remained in good health ; these pi’isoners
are in a different part of the building, and have had no communica-
tion with the deceased, as they do not belong to the same class of
prisoners.
“ There are two night watchmen on duty, who go round the cells
constantly during each night, and who instantly report any case of
illness among the prisoners to the hospital attendant, who is provided
with medicines and directions for an emergency.
“ Francis Rynd,
“ Medical Superintendant of Convicts.
“John Lamb,
“ Governor.”
A second case occurred on the 37th Fehruarj'^, and seven new
cases on the followmg day, the 28th, when the disease suddenly
disappeared.
It is important to state, that “the depot” wliich was consti-
tuted for the accommodation of 200 prisoners, contained at the
breaking out of the disease above 300 inmates (3 bemg lodged
in each cell instead of 2). On the 27th February 100 prisoners
weie removed to Newgate ; from that day no new case occurred
in the depot or in Newgate, wdiere the inmates of the convict
depot were received.
In the Hibernian School, Phoenix Park, an institution for
the reception and education of the children of soldiers, tlie
disease suddenly commenced on Wednesday night, 12th Sep-
tember, 1840, and continued until 3 o’clock on the following
Friday, the 14th, when a perfect cessation seemed to take place"^
Within that period 00 children were attacked, of whom 21 died.
The disease then became much milder, there being only one
additional death up to the 0th October, when the disease dis-
appeared.
^ There were in the school at the onset of the attack, 303 bo\^s,
43^girls. Tlie total deaths were 21 boys, 1 girl.
I his scliool is remarkably well situated, on very high ground
over hmestoue gravel, and with a considerable fall to the river
32 Rejwrl of the Commissioners of Health, Ireland,
Li£fey, which runs with a rapid stream over a gravelly bed, at
the distance of 460 yards from the school, and 92 feet below
the level of the parade or play-ground. The dormitories are
large, airy, well ventilated, and not crowded ; and the children,
prior to the attack, were remarkably healthy, the daily average
in hospital having been ordy 7. The children of the Hibernian
School may be considered to have been almost as perfectly pro-
tected against contagion as the convicts in Smithfield depot.
The attack, progress, and duration of the disease in these two
instances present, in our opinion, the characters of an epidemic,
not of a contagious disease.
There is another very remarkable circumstance to be noted
in connexion with the occurrence of cholera at the Hibernian
School. The village of Chajpelizod is situated on the banlis of
the Lilfe}^, nearly at the point where the river approaches near-
est to the Hibernian School, and is very much below the level
of the School, the river being, as before observed, 92 feet below
the level of the jolaj'^-ground of the school. It is the seat of a
flax-mill, and is densely inhabited by a poor population of 1,575
persons. Tliis village, from its situation on the great western
road, and from its proximity to Dublin, is more than usually
exposed to the admixture of strolling mendicants and poor
travellers, who might naturally be supposed to carry contagion
with them ; yet while the Hibernian School, containing about
400 inmates, placed apparently in the most favorable locality,
suffered so much, two cases only occuiTed during the whole
visitation of the epidemic among the ill-circumstanced, poor,
and crowded popidation of the village of Chapelizod.
In the small village of Castleknock, about two miles from
Dublin, and about one mile from the Hibernian School, also in
a healthy, high, and dry locality, containing about 200 inhabi-
tants, the disease suddenly broke out at 2 o’clock, p.m., on Sa-
turday, the 25th of August, 1849, and between that hour and 2
o’clock, A.M., on Mondaj^, 27th, a period of 30 hours, 25 deaths
occurred. During the remainder of the 27th no new case ap-
peared ; occasional cases appeared up to I9th September, when
the disease totally disappeared.
Maynooth and Kilcock are two towns in the County of Kil-
dare, on the great western road, of about equal size, each con-
taining about 2000 inhabitants, and about four miles asunder,
both great thoroughfares. In respect of inhabitants, as to mode
of living, habitations, and employment, there seems to be a per-
fect similarity, or if there be any difference Majmooth has the ad-
vantage,but the difference in their liability to cholera was remark-
able From the 7th June to the 3rd October, 1849, 141 cases oc-
curred in Maynooth — 47 deaths — while not a single case occurred
among the inhabitants of Kilcock. One case only occurred in
the town, that of an officer of the railway, who travelled down
in the train from Dublin. It is also remarkable, that during
the previous outbreak of 1832, Ixilcock was also free from any
33
On the Fjpidemics of 1846 to 1850.
indigenous case; the onl}'’ instance of cholera that then occurred
was in the person of a visiter from Dublin to the races, while
in 1832 there were in Maynooth 231 cases, 33 deaths.
In the County Meath similar remarkable cii’cumstances
occurred in reference to the towns of Kells, Navan, and Trim.
In Kells, containing 4,000 inhabitants, there occurred between
the 24th June and 16th August, 1849, 330 cases, 156 deaths.
In Navan, containing about 5,000 mhahitants, there occurred
during the whole time of the visitation of cholera only 38 cases,
16 deaths. In Trim, containhig 2,000 inhabitants, only six
cases occurred; of these, one was a gentleman who “was sick
on his arrival. The second, a poor laboru’er, who came sick
mto town from a distance of four or five miles. The other foiu’
were among residents, at different periods in the months of
July, August, and September, and in every instance confined to
the fii’st attacked, although in some of the cases the exposime
to contagion was most perilous.” Instances lilfe these might
be multipHed from almost every quarter of Ireland ; hut those
adduced appear to us sufficient to establish the two important
points already adverted to, viz., that cholera originates without
contagion, and that it is not seen to spread where there is con-
tinued exposure to contagion. Fever or other diseases uni-
versally admitted to be contagious, do not exhibit the singular
feature of visiting the dense population of some one town with
such severity, and passing by almost untouched the population
of a neighbouring town, hi every respect apparentlj'’ shnilarly or
worse ch’cumstanced.
We are gratified to he thus able to confirm by facts the view
put forward by us in our Circular of the 1st September, 1848
(see Appendix B, No. 1), as to the little apprehension to he en-
tertained of the contagiousness of cholera ; views which must
so materially tend to iirocure for the sick, from their relatives,
the requisite attention which otherwise might not he afforded
through unfoimded apprehension of infection.
The following table gives a list of all the Towns of Ireland
containing 2,000 inhabitants and upwards, distinguishing those
from which cases ot cholera were reported, those from which
there ivas no report of its appearance, and showing the number
of cases, the number of deaths, and the date of the first and
last case in each town : —
n
Towns of Ireland containing 2,000 inhabitants and upwards, distinguishing those from which cases of cholera were reported, those from which there
was no report of its appearance, and showing the number of cases, the number of deaths, and the date of the first and last case in each town : —
34
IXeport of the Commissioners of Health, Ireland,
I
J
On the Epidemics of 1840 to 1850
35
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8G Report of the Commissioners of Health, Ireland,
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On ihe Epidemics ^1846 to 1850
37
TABLE — continued.
38
Report of the CoDitHtsui jtlers of Health., Ireland,
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39
On the ’^indcmics q/l84G to 1850.
With a view to' elicit information on the disputed question of
the contagion of Cholera, we addressed to the several Medical
Officers through the country, from whom Reports were received
of the first appearance of Cholera, the following circular .
“ Central Board of Health,
“ 13, Ely-Place,
“ Dublin, 1849.
“ Sir, I am directed by the Central Board of Health to acknow-
ledge the receipt of your letter of the inst., notifying the occur-
rence of cases of Cholera, at , and I am to request you will
forward for the information of the Board, the particulars required in
the headings of the columns of the enclosed form of report.
“ The Board will be obliged for any information you may be able
to supply, as to "whether the patients had been long resident at
, or had lately come from some place where Cholera pre-
vails ; or had had communication "with persons in that disease, also,
whether the second case had access to the first one.
“ I have the honor to be. Sir,
“ Your obedient servant,
“ W. H. Hopper,
“ Secretary.
“ To Dr ”
To tliis thirty-seven replies were received, which may he
thus classed : eight doubtful, six in support of the views of the
first attack in the locality, owing its origin to contagion, and
twenty-three rephes, stating that the attack could not be traced
to importation or contagion. We subjoin a few extracts on
both sides of the question : —
Belfast Union, December 6th, 1848, (Di’. Reid). — “A case of
Asiatic Cholera was admitted into the Fever Hospital at 9 in the
morning of Monday last, and died at 74 in the evening.
“ The patient, Thomas Tiernan, and his family, had removed on
Tuesday the 28th ult., from a part of Edinburgh, in whieh there had
been no case of Cholera, to an entry or close in that city in which
this disease had prevailed for some weeks, * » * *
he aiTived at Belfast on Saturday morning, suffering from Diarrhoea,
and was admitted into the probationary ward of tlic woi'khouse in
the evening.”
To the supposed contagion of this case, the attack of
Cholera in Belfast, in both workhouse and city was attributed.
Mr. Phelan was directed by the Commissioners for adminis-
tering the Laws for the Relief of the Poor in Ireland, to report
on this case, and the following is an extract from his observa-
tions : —
Belfast, January IStli, 1849 (Dr. Phelan). — “ But on close inquiry,
this opinion of contagion appears to be scarcely well founded. I find
that Tiernan, the first case, was some hours in the probationary ward
in the front of the workhouse, and next transferred to the Fever
40 ~Report of the Commissioners of Health, Ireland,
Hospital, wliere he died in a few hours. The next case (Sherry), 7
days after got ill in one of the upper wards of the male portion of the
Infirmary, at the rere of the workhouse ; on close inquiry, it is stated
to me that she had no communication whatever with Ticrnan.
“ Again, a boy got ill in the boys’ dormitory, a place entirely
detached from all those portions, being a shed at the rere of the male
idiots yard, and soon after a woman got ill in the adult female ward,
neither of whom, it is said, had the slightest communication with
others sick, or with parties attending them * * * *
Although all the cases I have mentioned slept in beds, having one,
two, or three in the same bed, not one other that slept in such beds
got Cholera.”
Neiv-Ross, 5th March, 1849 (Dr. Rossiter). — “I have made every
inquiry, and ascertained that the parties first attacked with Cholera
had all resided in the places where they were seized with the disease
for many months, and in the town for several years, and that none of
them had been in any locality where Cholera was prevalent, or had
communication with any person affected with that disease.”
Ca/uV, 21st March, 1849 (Dr. Bagnell). — '' The first case was a
man who came from Limerick ; yesterday a woman died here, who
also left Limerick the day before, both cases were in comfortable cir-
cumstances, and both proved fatal — this day four additional cases have
been reported to me, one fatal, thi’ee others still alive, but one quite
blue and sinking, the others not so bad ; in all six cases, three fatal.”
Armagh Workhouse, 14th April, 1849 (Dr. Riggs). — “Respecting
the recent outbreak of Cholera here, I beg to give you the following
particulars : —
“ On Saturday last, the 7th inst., a strong wdnd set in from the north-
east, of a keenly piercing nature. This wind blew in a direct line to
Armagh, from Belfast, where Cholera is now prevalent, and on that even-
ing a girl aged 12 years, when in the female school of the workhouse,
Avas suddenly attacked Avith malignant Cholera, aaLIcIi proved fatal in
14 hours. This girl Avas an inmate of the house for nearly 2 months,
and had had no communication Avhatever Avith any infected person, or
place ; I may mention that about the same hour a man Avas suddenly
attacked Avith this disease about a quarter of a mile from the AA’ork-
house, on the Belfast road, and has since died.
“ On Sunday evening 5 persons were suddenly seized Avith Cholera
in the Avorkhouse, and, as you are aAvare, for 3 days the disease conti-
nued to increase Avith much frequency and fatality. During this
period the Avind continued in tlie same point, and on its shifting to-
Avards the Avest, there Avas an evident decline in the virulence of the
malady. The rapid and almost instantaneous manner in Avhicli many
persons were seized in all parts of tlie house (they Avere entirely sepa-
rated. from each otlicr), proves unquestionably that the poison of
Cholera Avas carried by the atmosphere, and that the disease on this
occasion Avas not propagated by contagion. Up to the present time,
the persons attacked Avith Cholera Avere almost all in a delicate state
of health, many of them being already inmates of the hospital.”
Macroom, 20th April, 1849 (Dr. Crooke).— “ The individuals
seized Avith Cholera had been lor some time inmates of the auxiliary
AVorkhousc, and it is impossible there could luiA'C been coiuinu-
On the Epidemics of 184 0 to 1850. 41
nicatioii with any locality Avhei’c Cholera prevailed, or with any person
in that disease.”
Lishttrn Union, Lisburn, 28th April, 1849 (H. M‘Call) — “In my
last, I took the liberty of referring to some facts, tending to prove the
infectious nature of Cholera. I have now to state some circumstances
of an opposite cliaracter — (facts referred to in former letter of April
19th, Avere the circumstances of two Avomen employed to Avash the
clothes of Cholera patients, having died of the disease).
“In 1832, when the disease raged extensively in Belfast, the paAAur-
hrokers came to a resolution to cease taking pledges, hnt three or
four ran the risk, and continued to do business during the entire
period of the attack throughout the tOAvn. I called on one of them
a few days since, and he states that none ot those caught the
disease, although he himself had (ineautiously) received clothing
Avhich had been over a deceased Cholera patient. In the present
period no pawnbroker has taken the disease ; yet it is astonishing the
risk encountered by the people in that business, as the friends of
Cholera patients make no scruple to pledge clothing, in many cases
just taken off persons ill of the disease. These facts coupled Avith
those to which I referred in my last, are at least Avorth notice, if it
Avere only to shoAV how many arguments can be adduced on both sides
of the question.”
Ballinnsloe, 29th April, 1849 (Dr. Colahan). — “ As to those persons
first attacked by Cholera, I have to observe, that the 14 cases occurred
simultaneously during the night of Sunday the 22nd. At an early
hour the folloAving morning, being informed of the eircumstance, I
ascertained that this number had been, some in the beginning, others
in the collapsed stage of the disease. During the day (Monday),
several cases in addition, amounting, as reported, to 32, occurred at
different intervals, and as stated in my observation in the enclosed
form, had not communicated in any way Avhatever with the deceased,
those attacked during the day having slept the previous night in
different dormitories ; those first attacked appear to have been in the
Avorkhouse from 3 to 8 weeks, none of the large number of the attend-
ants or others engaged in the treatment have shown any symptoms
of the disease.”
Tullamore, 30th May, 1849 (Dr. Moorehead) “ The first person
attacked AAdth Cholera in the Avorkhouse Avas admitted a pauper,
October 20th, 1846, since Avhich she had not been where Cholera pre-
vailed, nor had she any communication Avith persons in tliat disease ;
she had been a remarkably healthy strong Avoman, of great moral
courage, high spirits, and cliecrful disposition.”
We have nothing to alter or modify in the advice given in
our circular of the 1st Septemher, 1848, Avith regard to future
arrangements, should unfortunately Cholera again visit us ;
Avliich, in relerence to medical treatment, may be summed uj)
in providing prompt dispensary attendance for the sick poor
Avho may Avish to remain in their oAvn homes, and hospital
accommodation for those avIio stand in need of it.
Proposals Avere made, and in a fcAV instances arrangements
were put in practice, to carry medical attendance beyond this, by
42 R(‘j)o)i of the CommiHuioners of Health, Ireland.
means of what was called Domestic Visitation, that is, sending
into the localit}^ in which the disease appeared. Medical Inspec-
tors, whose duty it was to make rounds of visits on all the poor
families in the streets or lanes in the vicmity, to inquire into
the health of the inmates, and to administer medicine to them.
We do not recommend the practice ; such a system cannot be
carried out without an appearance of prying inquiry, which is
in general ill received. It cannot be efficient ; for a large por-
tion of the male population, and often a portion of the females
of the district, must be away in various places a great portion
of the day at their several occupations : even the provision
of inspection is calculated to lead to procrastination in
seeking relief, as those attacked by premonitory symptoms are
rather induced by the expectation of the Inspector’s visit to
defer prompt application to the district Dispensary; and in
some instances that came under the knowledge of the Board,
the feeling of the people visited in this way was the very oppo-
site of gratitude, the Inspectors were maltreated, the supposi-
tion being taken up, and the rumom’ rapidly spreading, that
death had occurred from the medicines thus intrusively ad-
ministered.
We have therefore only to advise in respect to future
arrangements, that in the event of a visitation of Cholera, the
greatest facilities for medical relief should be presented by
providing Dispensaries and Hospitals to aftbrd by night as well
ns by day, the promptest attendance on all applicants, and that
the greatest publicity should be given by posted notices of
the situation of such Dispensaries and Hospitals.
We have the honor to be.
Your Excellency’s
Obedient faithful servants,
Philip Cramptox.
H. Marsh, ji.d.
D. J. Corrigan, m.d.
SJO*»'7
I
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^"'(Wi'fTnt .'Wu AidllpiOr^:iu^^i“4
•?
PLAN AND SECTIONS or TEMPORARY PLVER WARDS
OF ECONOMICAL CONSTRUCTION
FOR 50 PATIENTS
PREPARED FOR THE CENTRAL BOARD OF HEALTH, IRELAND.
f?/"
Stf/r Zt//' /t/t/Vy/tr/ //i^ hf7frr^^x O'^/Z'/h'rr/
Zl/ Y/t/tf (OuZ ■SfZ/.f tofjr \3
ZT/i/rrJZ(?nr^f f/tryi-fktrZ- (’njrZsf i /3i»r/rjs aporf-yJoarj
fr/i/rn/Z/rrx to t/ra/Yj. f//c7t\( oty/Z ei’ery t/tm//
dir fmi7dma iyy77rf>f/ft . Jer r^o/v /zcr^//ya7^'r7f^jfZans ffatr(Z.i^et4
{7e£> r:i/yy>'
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J'tTjfY’rtjfk-
43
APPENDIX A.
No. 1.
Dublin, March, 1847.
Gentlemen, — I have the honor to submit the accompanying draw-
ings, which have been prepared in accordance with your instructions,
for tlie erection of Temporary Fever Wards of a simple and economical
constniction.
The following are the particulars of their construction, arrangement,
and cost : —
The buildings are intended to be erected with wood framing, as sho'wn
on the Sectional Drawing B, and to he hoarded with rough hoarding,
nailed on the outside of the studs or framing ; the hoards to have a lap
of one inch; the floor to be formed of inch deal, resting on joists
4 inches by 2, and 15 inches from centre to centre, and supported on
dwarf walls.
The sides of the building to be 7 feet 6 inches high, resting on low
dwarf walls of brick or stone, as shown in Section ; the width of the
building to be 15 feet 6 inches, which will allow a 3 feet 6 passage down
the centre of the ward, and tiie heads of the beds to be j)laced along
each 'side.
The roof to be also boarded with inch boai'ds, having IJ inch lap, and
if thought advisable hereafter, it can be covered with “ asphalte felt, or.
tar paint.”*
The Avindows to be formed on both sides, to be 3 feet by 2 feet C inches
high, to hang on centres for opening, and glazed like common green-
house lights, and to have proper lines for opening and closing.
On the ridge of the roof small ventilating hoppers to be foimed, and
about two of them to be placed in a length of 50 feet of roofing. By
this arrangement the breath of the patients will be drawn toAvards the
roof, leaving the centre passage of the room the most free from infec-
tious air.
Plan A shoAvs an arrangement for a building capable of accommo-
dating 50 beds, spread 1 foot 5 inches apart; it exhibits tAvo AA'ards, one
for men, and another for Avomen, Avith a fire-place betAveen. I purpose
the constniction of air-flues, 14 inches bj'' !) inches, in the chimney-
shaft, to be carried up from the bade of each fire-place to the chimney-
shaft above the roof, having an opening from the upper j»art of the
room into the air-flue for the escape of vitiated air, Avhich Avill be draAvn-
into it by the cuiTent of Avarm air in the air-flue, and be of much service
in cold AA'eather Avhen the AvindoAvs cannot Avell be ojioned. At each
external gable end of the AA’ards an opening of about 1 foot 0 inches
superficial is to be left, and to be covered Avith a perforated zinc plate
fixed against the boarding.
Ihe bedsteads to be formed of planed boards, 0 feet long, resting at
the foot on a deal tressel, and at the head on a ledge, formed in an
instance, to be covered Avilh asidiolto felt, the boarding
might be f mch thick U hoards out of a 3 inch plank.) » v o
44 Report of the Commissioners of Health, Ireland,
economical manner, by the constructive arrangement of the frame work
of the side walls. By this method a deal plank 12 feet long, with two
saw cuts down, will make two bedsteads of the cheapest possible con-
struction.
The Sectional Drawing C represents the arrangement of tiie bed-
steads, and the framing of the wood-work of the windows, chimney-
shafts, &c.
For the accommodation of a greater or less number than the 50 bed-
steads shown in the accompanying plan, the Avards, which are 50 feet in
length each, Avill only require extending or shortening ; and for every Bvo
feet added to the building space Avill be obtained equal to one additional
bed, 3 feet 11 inches lineal space along each side Avail being the allot-
ment for each, Avith the beds jAlaced 1 foot 5 inches apart.
The cost of the building for 50 patients, according to the foregoing
particulars, and the plans refeiTed to, including bedsteads, Avill be
.£1 10s. per foot; and for every tAvo feet additional length added to the
building, being the space, as before stated, for providing each additional
bed, a cost of £3 may be calculated.
When it may be necessary to provide additional rooms for conA'ales-
cents, or for other purposes, a similar kind of building can be placed at
the rear of this, communicating Avith it by door-AA’ays, to be formed in
the side enclosure.
I have the honor to be Gentlemen, your obedient Seiwant,
{Signed) George Wilkinsox,
Archileot Poor-law Commission.
To the Commissioners of the
Central Board of Health.
w
DRAWING FOR AN ECONOMICAL BEDSTEAD PREPARED FOR THE
CENTRAL BOARD OF HEALTH, IRELAND.
OUTSIQS WSATHtR eOAWDINC.
THE B
LOOSE
C STEADS TOBEPOfjl
i^L BOARDS PLANI
SURFACES
I^D WITH
ON THEIR
BEARER y’.
^SMALL REBATEHALFAN INCH W
TO KEEP THE BOARDS INTHEIP.
END VIEW
FAMILIAR VIEW OF BEDSTEAD
T'orsf/v, ia/>.‘
SIDE VIEW OF BEDSTEAD
• ' * t
t '
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E ^
' V-
tii&
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On the Epidemics <?/ 1846 to 1850.
45
No. 4.
REMUNERATION OF MEDICAL OFFICERS.
Central Board of Health,
64, Lotver Gardiner-strcet, Diiblin.
The following is the scale of remuneration acted upon since the
formation of the Central Board of Health, in March, 1846, for Medical
Officers appointed to Temporaiy Fever Hospitals and Dispensaries,
established under that Board, in pursuance of the provisions of 9 Vic.
c. 6, and 10 Vic. c. 22, or acting under the Board : —
For attendance on a Temporary Fever Hospi-'
tal, established within the town or district in
which the Medical Officer resides, in addition >
to any permanent salaiy he may receive as
Medical Officer of any existing Institution,
For attendance on a Temporaiy Dispensaiy \
under similar circumstances, . . . . j
For attendance on Temporary Fever Hospital 1
and Dispensary together, under similar cir- >
cumstances, ;
For attendance on a Temporaiy Fever Hospital, 1
Avhere Medical Officer is sent to a distant >
district 3
For attendance on a Temporary Dispensary, |
imder similar circumstances, . . . . /
For attendance on Temporary Fever Hospital )
and Dispensaiy, under similar circumstances, J
i")s. per day, or
^91 5s. per annum.
5s. per day, or
i£91 5s. per annum.
10s. per day, or
iS182 10s. per- annum.
1 guinea per day, or
£383 5s. per annum.
1 guinea per day, or
£383 5s. per annum.
26s. per dej"^, or
£474 10s. per annum.
Separate provision is made for compounding and dispensing medicines.
For Medical Inspection, under dmectioii of ( guineas pei day.
Board of Health 1 n-
1 ravelling Bxpenses.
No.
CIRCULAR.
Central Board of Health,
' Custom House, Dublin,
11 th Matj, 1847.
Applications having been made to the Central Board of Health, to put
in force those provisions of the Fever Act, iO Victoria, cap. 22, which
relate to measures for the prevention of fever, such as the cleansing and
pulifying of tlie habitations of the poor, and the I'cmovul of nuisances
&c., and for the proper and decent interment of the dead, the Board of
Health deem it necessary to draw the attention of the various Belief
Committees to Sections IX. and XVI. of the said Act, from which it will
be seen that the Board of Health are not authorized to issue any order
or enforce any measures_ in relation to the cleansing, ventihitiim and
puiil}ing of the habitations of the poor, the removal of nuisances or
the interment of the dead. These duties are devolved, hy the Act
wholly on the respective Belief Committees throughout the country'
who are armed with ample powers for the pui-pose, ivithout neediu" aiiv
authority from the Board of Health. ° ^
The following are the provisions above referred to : —
46 Report of the Commissioners of Healthy Ireland,
IX. And be it enacted, that it shall be lawful for such Relief
Committee to give all such directions as shall seem to them ne-
cessary and expedient for performing all things necessary for
preventing the communicating of fever or other epidemic disease
within their respective electoral divisions or districts ; and for
that purpose to direct that all streets, lanes, and courts, and all
houses and all rooms therein, and all yards, gardens, or places
belonging to such houses shall be cleansed and purified, and that
all nuisances prejudicial to health shall be removed therefrom ;
and that all houses in which any sick person shall be, or shall
have been, shall be ventilated, fumigated, and whitewashed, the
windows and doors thereof opened, and all beds, bedsteads, bed-
ding, and furniture thei’ein be exposed to the ah, and be washed
and cleansed, and, if absolutely necessary, be burned or destroyed,
and all other measures which to such Relief Committee shall
seem requisite for the purposes aforesaid.
XVI. And whereas it is expedient to provide for the proper
and decent interment of the deceased destitute persons, who
shall die of fever, or other epidemic disease, in any electoral
division or district for which any Relief Committee shall have
been constituted as aforesaid ; be it enacted, that it shall be lawful
for any Relief Committee to provide for the proper and decent
interment of such destitute persons as may die in such electoral
division or district as aforesaid, of fever or other epidemic
disease, or while receivmg relief, and to defray the charge of the
same out of the funds which may be at the disposal of such
Relief Committee for the purposes and under the provisions of
the said recited Act of this Session, or of this Act.
The Board of Health can do no more at present than oiler some
general suggestions.
1st. In reference to the provisions of Clause IX. for cleansing and
purifying the habitations of the poor, and for the removal of nuisances.
The present time appears to be a favol-able opportunity for enabling
Relief Committees to eflect these objects -with little expense, as the
services of a sufficient number of able-bodied destitute persons, now
receiving gratuitous out-door relief, can probably be obtained for a
trifling addition of rations or monQy, who can be employed, under
proper superintendence, in whitewashing the rooms and passages of the
habitations of the poor, and in removing nuisances, such as collections
of manure, contents of ash-pits, &c. In whitewashing, the reflation
should be strictly enforced of having the lime always slacked immedi-
ately previously to using it, and of laying on the whitewash whUe still
hot. After whitewashing, the floors and passages should be well
sprinkled with a freshly made solution of chloride of hme, in the pro-
portion of about a quarter of a pound to a gallon of water. A short
printed notice should also bo freely circulated, impressing on the people
the necessity of avoiding sick rooms, Avakes, and croAvded meetings,
and the great importance of pure air, free ventilation, and cleanliness
of houses, clothes, and persons, as among the best safeguards against
contcicion* it* i •
It is advisable not to limit the Avorks of cleansing and AAdutCAA-aslung,
and the removal of nuisances, merely to the localities or places AAdierc
fever may have actually appeared, but to carry out such measures, on a
systematic and extensive plan, through the habitations of the poor
generally. The details for eflecting this can be best arranged by each
Local Relief Committee.
2nd. In reference to inducing cleanliness of clothing and person
among the poor,— measures so essential to health and the prevention of
infection. A rule has been adopted in some instances, of insisting upon
aU applicants for gratuitous relief coming to the provision depots with
47
On the Epidemics <^184G to 1850.
at least face, hands, and hair clean. This regulation has been attended
with good results. The Board of Health, however, tliiuk that the prin-
ciple might he carried farther, with great advantage, and that habits of
cleanliness might be rapidly induced, if in every district in convenient
locahties, washing-houses on a simple and economical plan were estab-
lished, to be kept open for a certain number of hours per day. It would
be only necessary to provide each washing-house ivith a large boiler for
the supply of hot water, and with ranges of wooden troughs divided into
compartments, each of which would serve as a separate washing-tub,
with a plug at bottom to allow of the dirty water being earned off pre-
viously to filling it anew for the next appheant. If a drying-ioom for
clothes could be attached, it would of course be a most desirable addi-
tion ; but the Board fear that an attempt to do too niuch at first might
only tend to prevent practicable measures being carried into execution.
.3rd. The separation of the sick from the healthy. The early removal
of the sick to hospital is a measure of the greatest importance in check-
ing the spread of disease.
To effect this with expedition and certainty, arrangements must be
made, —
1st. For procuring the earliest intimation of the appearance of iUness.
2nd. For the removal of persons affected.
To attain the first object, printed papers should be posted irp request-
ing the poor to give immediate notice of the first appearance of illness
in their families, at the gate of the hospital, where the porter, or a
person appointed for the purpose, should keep a book in which he may
enter the names and residences of the applicants for admission — a
certain hour, say from 9 to 10 o’clock in the morning, being allotted for
this object. There should then be in cities or towns, as in former
epidemics, one or more medical inspectors, according to the extent, for
each hospital district, whose duty it should be to visit, as soon as possi-
ble, the cases reported each morning, and such other cases as they may
hear of, and to return to the office by a certain hour a list of those
persons who are fit subjects for removal to hospital. On tlie lists being
returned, a light covered vehicle should be in readiness to convey the
sick to hospital in the course of the same day. The books kept as above
will, besides, be most useful in affording information as to the actual
state of disease, its diminution or increase in each district, and the
corresponding amount of accommodation required.
4th. Interment of the dead. — On the provisions of Clause XVI. the
Board of Health deem it necessary to offer only the following sugges-
tions ; — That graves should invariably be sunk to a depth of five feet ;
that the surface of each grave should be beaten hard ; that where burials
have already taken place, leaving the coffins iiearer to the surface than
five feet, clay should be carted in to cover the graves to a sufficient
depth, and that, wherever obtainable, yellow clay should be preferred
for this purpose ; and, finally, that when new gi ao'e-yards are opened,
localities should be selected at least a quarter of a mile from any town,
village, or hospital, in a sufficiently exposed situation to prevent the
accumulation of malaria.
By Order of the Board,
Anriiuii I\IooRK, Score tar >i.
48 Report of the Commissioners of Health, Ireland,
No. 0.
LETTERS FROM THE CENTRAI, BOARD OF HEALTH TO THE RELIEF COMMIS-
SIONERS RESPECTING RATIONS PROPOSED FOR THE DESTITUTE POOR UNDER
THE TEMPORARY RELIEF ACT.
Central Board of Health, Dublin,
10th March, 1847.
8ir, — Tlie Central Board of Health having had under consideration
yonr eonnnunications of the 2nd and 5th inst. respectively, relative to
the rations proposed by the Belief Commissioners to be allowed for
adults, I am directed to state for the information of the Belief Commis-
sioners, that the Board of Health are of opinion that the rations therein
submitted to them for their opinion are under the circumstances reason-
able allowances.
The Board of Health, however, suggests that in all instances ■where
practicable, the food should be given out in a cooked form ; as food,
ho-wever good in itself, will, if not sulhciently cooked, not afford its full
supply of nutriment, and it will moreover jn’edispose to attacks of
dysentery and diarrhoea now so prevalent through the country'. They
likewise suggest that the food given out should be varied occasional^ ;
as for instance, on one day that liread rations be given ; and on anotlier,
soup and bread ; or meal and rice porridge, with bread, &c.
They also recommend as a general princijile, that a oonsiderable
proportion of the nutriment should be administered in a solid or moder-
ately consistent rather than in a veiy ffuid form ; and they suggest to
the Belief Commissioners, the propriety of occasionally consulting the
medical officers of dispensaries as to the effects of particular articles of
diet, and the substitution of others, according as the preservation of
health and, the appearance of any sickness may seem to demand such
alterations.
I have the honor, &c.
A. Moore,
Sccrelarij.
To Win. Stanleij, Esq.
Secretanj,
Relief Commission.
Scale of Rations jiToqiosed by the Relief Commissioners, and referred to in the
foregoing Letter.
IHb. of bread;— or, lib. of biscuit;— or, lib. of meal or flour;— or,
1 quart of soup, thickened tvith a portion of meal according to the
known receipts, and J ration of bread, biscuit, or meal in addition.
Central Board of Health, Dublin.
lUh May, 1847.
Sir,— T am directed by the Central Board of Health to acknowledge
the receipt of your letter of the 5th instant, relative to the scale of
rations for adult destitute persons, and requesting the views of the
Board ns to the allowance proposed for children under nine years of ago.
The Board of Health are of opinion that the scale of rations proposed
by the Belief Commissioners,— viz;., half for persons under nine years of
a"e, and full allowance for persons over that age— is, under the circum-
stances, probably the best that could be devised ; for although a more
divided scale is useful and necessary in the dietary of large institutions,
containing persons of different ages, the Board of Health fear that ain
attempt to carry out, in out-door relief under 10 ^ ic. cap. 7, a scale of
49
On the Epidemics of 1846 to 1850.
rations move sub-divided than that recoinniended by the Eellef Commis-
sioners, would be attended with complication in the arrangements, and would
be productive of unceasing disputes. _ « , ,
Considering these circumstances, and the varying ages of chddren on the
relief lists, the Board of Health concur with the Eelief Commissioners in the
scale proposed. . v
The Board of Health now desire to draw the attention of the Eelief Com-
missioners to the communication from the Board of Health of the 10th
March, m which they recommend that “ in all instances where practicable,
the food should be given out in a cooked form.” They are now, from reports
which have reached them, anxious to urge on the Commissioners the neces-
sity of taking measures to have this recommendation acted on, without
exception, in all instances. The Board of Health feel it only necessary to
observe, that they fear, unless the principle be fully earned into effect, of
giving out the food only m a cooked form, there will be always both an
abuse and a serious evil of another kind to contend with, the abuse is,
the sale of raw meal, for which purchasers are always to be foimd, to
whom even the poor requiring the food for themselves or family will dispose
of it for money, tea, or tobacco ; and the serious evil is, the consumption of
meal or rice, but more particularly Indian meal, in a raw or badly cooked
state,* which will predispose to and aggravate dysentery and dian’hcea, ab’eady
so prevalent through the country.
The Board of Health also wish to renew their recommendation in their
previous communication already referred to, of 10th March, advising as a
general principle, that “ a considerable proportion of the nutriment should
be administered in a solid or moderately consistent rather than in a very
fluid form.” This principle is the more necessarj^ to be attended to on the
approach of warm weather, when soup, containing a large proportion of
veget.able matter, is so liable to ferment and become sour. The Board of
Health would, therefore, suggest that instead of soup ration, under section
26, there should be henceforth substituted : —
1 pint of soup and 16 ozs. of bread, as the daily ration, on soup days. As
there are many different forms adopted for making soup, it may be useful to
bear in mind, as a general rule, that a pint of meat soup should weigh very
nearly l^lb.
In serving out stirabout made of oatmeal, or of oatmeal and Indian corn,
of oatmeal and rice, &c., in order to prevent all disputes and frauds, and to
prevent the error being committed, of mistaking bulk for nutriment, so as to
insure that sufficient nutriment is given, the rations should be estimated
not by the bulk when cooked, but by the actual weight of raw material:
thus, as the allowance per diem of meal for a ration is lib., care should be
taken that when cooked, each ration, whatever be its bulk, should contain
the equivalent of lib. of raw meal.
I have the honor, &c.
To Wm, Stanley, Esq.
Secretary, Relief Commission.
A. Moore, Secretary.
Extract from Regulations for Relief Committees : Section 26, above
referred to.
“26. One ration may consist cither— of IJlb. of bread;— or, lib. of bis-
cult or, 11b. of meal or flour of any gi-ain ;— or, 1 quart of soup, thickened
with a portion of meal according to the known receipts, and 1 quarter r.ation
of bread, biscuit, or meal in addition. Persons above 9 years of ao'e to have
one ration, under 9 a half ration, in the day. In all cases, where practicable
the food should be given out in a cooked form, and should be varied occa-
sionally, from bread rations to soup and bread, or meal and rice porrid<ve
■With bread. ‘ “
• Inspeotora liave reported that they havo aeon the people doTouring the raw Indian meal.
B
50 Report of the Commissioners of Health, Ireland,
Central Board of Health,
G4, Lower Gardiner-street, Dublin,
1st June, 1847.
Sir, — In reply to the request of the Relief Commissioners for the opinion
of the Central Board of Health, “ as to the allowance of rice which may
reasonably be made in the rations to destitute persons, in lieu of one pound
or other given quantity of Indian corn meal, the rice being considered to
have superior nutritious qualities, and an equal weight of it jdeldmg, when
cooked, a larger quantity of solid food,” — I am directed to state : —
1st. — That the tdlowance of rice which may reasonably be made in lieu of
Indian corn meal, should not be less than one pound and a half of rice in
lieu of one pound of Indian corn meal, where either grain is given alone, and
that the same proportion should be observed in a mi.xed ration, viz if half
a pound of Indian corn meal be given, instead of the standard ration of one
pound, that there should be given along with it three quarters of a pound of
rice to make the mixed ration equivalent to one pound of Indian corn meal,
and in like manner of all other proportions in which rice and Indian com
meal mixed may form a ration.
2ndly — That the Board of Health cannot hesitate to assure the Relief
Commissioners, that rice, instead of being superior, is much inferior to Indian
corn meal in nutritious qualities.
It is true that rice by steeping and boiling, may be made to furnish a
lai’ger bulk of apparently solid Ibod than will be furnished by an equal
quantity of Indian corn, and hence has probably arisen the supposition of its
being more nutritious, but the bulk thus obtained is deceptive as to the quantity
of nutriment afforded. Rice contains about 85 parts in eveiy 100 of starch ;
a given quantity of it will by steeping and boiling absorb a very large pro-
portion of water, and will swell into a large and apparently firm mass ; but
this mass will contain a very small proportionate quantity of nutriment. A
very simple experiment will satisfactorily illustrate this : one ounce of com-
mon starch boiled in the ordinary way, will form, with a piqt of water, a
firm mass, which from its apparent consistency will seem to be good substan-
tial food ; but the bulk thus formed, it is obvious, contains very little nutri-
ment. In like manner of rice ; one pound of it may be made to form, with
water, a starchy mass of five or six pounds’ weight, but the produce, as in the
experiment of the starch, is bulk, without eqmvalcnt nutriment. Tlie Board
of Health are anxious that their observations on this subject should be clearly
understood and widely disseminated, as the error is very generally prevalent
of supposmg, that in using rice or other similar substances, an amount of
nutriment is alforded equal to the bulk gained. The Board of Health do
not at all object to the use of rice as food ; on thq contrary, they highly
approve of it, pi-ovided it be furnished in sufficient quantity.
The Board of Health ai’e fully aware how necessary and how pressing, at
the present time, is the exercise of the strictest economy, but they are also
convinced, that if the use of a diet bo permitted, containing too large a pro-
])ortion of Iluid, deficient in the due cpiantity of nutritious elements, .and
ileriving its solidity principally from the presence of starch, the result must
necessarily be, in those living on it, debility of constitution, with consequent
inability to resist disease, and ultimately, increased expenditure m the cost
of relief, instead of saving. _ ^ i •
Tor the.se reasons the Board of He.alth deem it important that the P^"t-
ciple laid down in their previous communication of 11th hlay, shouldbe strictly
adhered to, viz th.at rations should be given out cooked, and in .as solid
form as possible, .and that they should be estimated, not bv the bulk when
cooked, but by the rule that each cooked ration should contain the cqiuvalent
of lib. of raw mc.al, the quantity originally sanctioned by the Relief Com-
missioners of the Board of Healtli.
I have the honor, &c.
To Wm. Stanley, Esq. _ A. iAIooiiK, Secretary.
Secretary, Belief Commission,
51
On the E'pidemics ^1846 to 1850.
Central. Board of Health,
G4, Lower Gardiner-street, Dublin,
June, 1847.
Sir,— The Central Board of Health have had under consideration your
letter of the 3rd instant, requesting to be informed — “ in how small a propor-
tion rice may be used with Indian meal, (if at all necessary,) without sacri-
hclng its useful properties, as a corrective of the prevailing malady of the
population ; or the advantage, if any, of the additional bulk it acquires in
cooking ?” and in reply, the Board desire to observe, that the precise pro-
portion for the object in view could not be fixed, as it would often necessaiily
vary according to circumstances of seasons, predisposition to disease, and
even individual constitutions ; but that as a general rnle, rice may be mixed
Avith advantage in almost any proportions, however small, with Indian meal,
and in larger proportions according as its cost may permit ; care however,
being always taken, as explained in previous letters of the 11th May and 1st
June, that each ration when cooked should contain its full equivalent of raw
meal and rice, as recommended by the Board of Health in the same com-
munications.
The Board of Health, although admitting the advantage of bulk occa-
sionally acquired in some kinds of food by cooking, yet taking into consider-
ation one of the forms of disease nOAv prevalent in Ireland, do not recommend
that rice should be used Avith the object of giving bulk by the absorption of
watery particles ; but on the contrary that cooked rations shoidd be given
out in as solid a form as possible, leaving it to the natural feelings of thirst
to supply the quantity of fluid necessary for healthy digestion. With the
object also of obviating the general predisposition to relaxation of the bowels,
Avhich will probably increase as the summer advances, the Board of Health
recommend the addition of some of the ordinary condiments to the stirabout,
of Avhich perhaps pepper Avill be found the most acceptable and the cheapest.
The Board of Health take this opportunity of acquainting the'' Relief
Commissioners, that they have learned tlu’ough the inspectors, and from
other sources, that a diminution in the prevalence of dlarrhcea, and a marked
improvement in the general health and strength of the people, have followed
upon the substitution of cooked food for raAv meal ; and they, therefore,
again recommend that every exertion should be made for extending the use
of cooked food in the distribution of rations.
While on the subject of diet, the Board of Health deem it of importance,
through the medium of the Relief Commissioners, to draAV the attention of
Reliet Committees, and of the people generally, to the fact, that a form of
disease now very prevalent among the people, resembling in many particul.ars
sea scurvy, is connected Avith or dependent on a defective nutrition, arismg,
not from deficiency of quantity, but from deficiency of quality or variety in the
food. The potato, although not containing a large jiroportion of nuti'iment,
is remarlcable as containing within itself all tlie varied elements necessary for
forming healthy blood ; no one of the substitutes for it, Avith the exception
of oatmeal, possesses this remarkable property ; and lienee the use of more
than one article of food is necessary in order to secure a sufficient supply of
the varied elements of nutrition, and thus to obviate the form of disease
referred to.
With this principle in view, the Board of Health, as tlic season of the year
noAV gives facilities for it, strongly recommend the admixture of onions,
leeks, scallions, or shallots, in^ cooked meal rations, or stirabout, Avhicli Avill
both act as condiments, and Avill also furnish some of the elements of nulrl-
tion essential for forming healthy blood. Onions are so rich in nutritive
qualities, that as a mere article of food, one ounce and a half may be consi-
dered as equivalent to .about one ounce of meal. On every opportunity, tlie
importance to health of using vegetables, such as carrots, ]),arsnips, and cab-
bage, along with meal, should be impressed upon the people.
it may not perhaps be out of place in these observations to make the
E 2
52 Report of the Commissioners of Health, Ireland,
people generally acquainted with the high nutritive qualities of beans and
peas, Avhicli, weight lor weight, contain ii-om 10 to 12 times as mucli nutri-
ment as potatoes. In those countries where rice is very cxten.sivelv used as
the food of tlie people, experience has taught them that rice by itself has low
nutritive qualities, but that the deficiency can be supplied by adding about
two ounces of beans, peas, or lentils, to each pound of rice. It must however
be remembered, that witli beans or peas, some other vegetable food must be
used, as, although possessing in a high degree some of the most important
elements of nutiition, they nevertheless do not contain a sufficient variety of
other nutritive elements, to support the human body in health.
I have tlie honor, &c.
„ A. Mooke, Secretary.
To Wm. Stanley, Esq.
Secretary, Relief Commission.
Appendix A., No. 7.
Temporary Fever Hospital at
TJniom
Opened under the Temporary Fever Act, on of
18 .
Report for Week ending Saturday, of 1850.
N uin ber of Beds which the Temporary Hospi tal 1
is capable of containing, . . • . J
umber of Beds provided, . . . • .
s
3
Females. |
Total. 1
Fever. I
Dysentery. I
1 rt
1 Ji
P
Other Epidemic or
Contagious Disiase.
(Slate name of
Disease.)
Remaining in Hospital on previous Saturday,
Admitted this week, • . . .
Total treated during the week, < . . .
Discharged,
Died,
Remaining in Hospital on this day, Saturday,
of
Total (as above), .......
Vacancies,
Nos. rejected for want of accommodation.
Date, day of 1 850.
Signature Medical Officer.
Tlie numbers in Hospital were —
On Sunday, •
,, Moiula)', . •
„ Tuesday, . .
,, Wednesday,
,, Thursday,
,, Friday, . ,
,, Saturday, .
Nog. Dig-
clmrgcd.
Nim. Re-
jected.
Nog. Ad-1
inlttcd. 1
Total, .
Tbo whole of the Medical Officers should sign these Reports, in order of appointment, where more
than one Medical Officer has been appointed.
On the Epidemics of 18-16 to 1850
53
Union, in the
•sKoiirAHasao
. i
^ ;
»
H
CD
•jooa Atojj\r g
•aowo«I -2
•ioJtJm.vi S
•auTAV g
*^3!a
Appendix A., No. 8.
Return of the Diets and Stimulants ordered in the Temporary Fever Hospital at ia
Week ended Saturday, day of 1850.
FRIDAY. 1
•^oou .\t0i.iv g
•40510, t -3
•.tonsiqiS. g
•aufAV §
•3^!a
>*
<
P
rn
a
p
•?ooir Avowy g
•40J40a 3
-.tojismAv g
■aujAA g
’%^\a
WEDNESDAY.
"}ooa Moijy g
•XojistqAi. g
‘o«!AV 3
•loia
TUESDAY.
■}ooa Avojjy g
•J0540J[ 3
•■^oqsiqAV g
•oujAV. g
•i^ia
MONDAY.
•jooa Mojjy g
•43540a 3
•lonsiUAi g
•3UJAV 3
•jasa
>•
P
P
CD
•?OOa M04.iy g
•4-»540,I 3
•■«on»|l|AV g
•3«!AV s'
•ostiosKi
*UO]BBlUlpV’ JO SH’fl
»g
ri
!*iAi
t
6
Date day of 1 850.
Signature :
54 Report of the Commissioners of Health, Ireland,
Appendix A., No. 9.
Central Board of Health.
Union. Dale
Keport on Temporary Hospital, under tlie Temporary Fever Acts,
at in the Electoral Division of
lio. and Names
of Electoral
Divisions
in Hospital
District.
No. of Rods
which the
Temporary
Hospital
is capable of
containing.
No. of lleds
for which
Certiiicato has
been issued.
Date of Certi-
hcate of Board
of Health for
the provision
of the Tempo-
rary Hospital.
Date of flrst
admission of
Patients
in Temporary
Hospital.
No. OF Patikkts i« Hospital.
Males. <
Females.
1
Total.
1
Fever.
1 >2
III
Patients — ^liow presented ,
for admission, . . j
Name of Medical OfiScer,
Medical attendance _ . '
(mode and times of) ]
Medicines, whence sup- '
plied — compounding of
Situation of Hospital as I
to healthfulness, and (
whether central for the f
District, . . . j
Light and Ventilation —
No. of cubic feet of air
allowed to each bed, .
Supply of Bedding, &c. .
,, Water, .
Dietary, including ordi-
nary forms of, and ex-
tras, .
►
Cleanliness, .
Nurses and Wardmaids —
Number and arrange-
ment of, .
'
Hospital llegistry ? How >
,, IBooks ikept,)
GENERAL
OBSERVATIONS,
including a short notice
of the type of Fever,
and ordinary durati on
of the attacks, com-
plication, sequela: —
tendency to relapse —
treatment generally
employed ; other dis-
eases prevalent with
Fever, &c.
OBSERVATIONS
OF
BOARD OF HEALTH.
Signaiurc_
Inspector.
On the Epidemics of 1846 to 1850.
Appendix A., No. 10.
Central Board of Health, Ireland.
55
U nion.
Return of Patients in Temporary Pever Hospital.
Names.
Duration in
Hospital.
Type of Disease.
Observations.
Appendix A., No. 11.
Central Board of Health, Ireland.
Union.
Return of Patients yisited at their own homes in_
by
Population about 1 i
S-Townland of -
Area j (
District,
day of 184 I
No. of House and Names of
Patients in each.
Disease
labouring under.
Observations.
Appendix A., No. 12.
Central Board of Health, Dublin, '
Wth October, 1848.
The Board of Health liave had under consideration those provisions of the
amended Fever Act, 12 Vic., c. 131, which have reference to the salaries of
the Medical Officers at the Temporary Fever Hospitals, and are of opinion,
that five shillings a day, hitherto allowed to Medical Practitioners for attend-
ance on Temporary Fever Hospit.als or Dispensaries within their own
districts, is only a reasonable remuneration for the labour aud risk incurred
in such attendance, and that it should not be departed from.
This amount of remuneration is recommended by precedent, as it appears
from Official Returns laid before the Board, that such Avas the remuneration
generally allowed to Medical Oflicers appointed to similar duties during the
prevalence of former epidemics of fever, viz., in the yc.ars 1816, ’17, and ’18,
and 1826, &c. ; and it has received the approbation of the Lords of the
Tre.asury, having been paid Avith their sanction from the commencement of
the present epidemic fever in 1846, up. to the passing of the amended Fever
Act, 12th Victoria, chap. 131, on the 5th September last.
56 Report of the Commissioners of Health, Ireland,
Representations have been laid before the Board of the expediency of
constructing a scale which might apportion the rate of renmneration to the
relative sizes of the Temporary Fever Hospitals, and the corresponding
amount of duty to be performed. The Board, after full consideration, are
convinced that it would be hardly pi’acticable to establish any such scale.
Tlie numbers under treatment in each Hospital must necessarily vary from
week to week, and if the numbers in Hospital Avere permitted to be the
criterion of the amount of Salary, the J\ledlcal Officer Avould be constantly
exposed to the imputation of retaining a greater number of patients than
necessary, in order to entitle him to a certain amount of Salary.
Another mode of lessening the expenditure for Medical Attendance has
been proposed for the consideration of the Board, viz., that the attendance
of the Temporary FcA'er Hospital should be given to the Medical Officer
already holding the Worldiouse Hospital, or some other appointment or
appointments under the Board of Guardians, and that thus, by giving such
Officer two or more medical appointments, the united salaries Avould amount
to a reasonable sum, although the rate allowed for any one might be verj' small.
The Board of Health consider that such an arrangement Avould be unjust
to the Medical Officer, and injurious to the sick.
If attendance on a Tempor.ary Fever Hospital be in itself worth a certain
rate of remuneration, that amount of remuneration should be given for that
particular duty, without reference to any other appointment Avhich the Officer
may hold — each duty should be estimated for, and paid for in respect only
to itself.
The practice of imjiosing several appointments on the same Medical Officer
on the ground of economy, is, hoAvever, open to another and more serious
obj ection : — it will be inj urious to the side poor. Every Practitioner requires
a considerable portion of each day for private practice, Avhlch is generally the
main soui-ce of his income ; and, if a greater amount of Hospital duty be
imposed on a Medical Officer than he can perform within fi’om one to three
hours at the very farthest, the sick poor must be neglected ; — no extent of
supervision, no inspection, hoAv often soever repeated, can prevent neglect in
such cases. It appears, by a return before the Board, that the average
number of patients in each Workhouse Hospital in Ireland, in the last Aveek,
has been 105. If such cases Avere like the ordinary cases in a FcA-er Hospi-
tal, similar in kind or type, the time required for mere attendance Avould not
be so great ; but Avhen it is recollected that there is not only this large
average number, but that it includes every variety of jMedical and Surgical
diseases, requiring, occasionally, operations and dressings, it is evident that
great care should be taken not to curtail, on the ground of economy, the
time re(|uireil for the due performance of .such laborious duties. In no
instance in Dublin is the duty of attending 100 patients, in a general Hos-
pital, imposed upon one Officer.
In England tlie practice has groAvn iq) of iMedical Officers undertaking a
greater ainount of iMc.dical attendance than they could themselves adequately
discharge, and of committing the esu’e of the sick poor to assistants engaged
for that purpose. The Board most stronjly disapproA'c of such a system :
for it is evident that there can be no sufficient security for the professional
knowledge or conduct of assistants so employed.
Adequate skill and attention can only be afforded and secured to the poor
by not imposing uj)on any Medical Officer any greater extent of public duty
than he can honestly and fairly discharge, Avithont trenching on his priA-ate
practice, and by requiring that he shall personally fulfil the duties of any
hledical appoiiitmcnt he may undertake. This course is not more clearly
pointed out by justice and humanity, than it is recommended by time economy ;
for neo-lect or bad management of the poor suffering under sickness or acci-
dent, will render them or their families a lengthened charge on the rates.
By Order of the Board,
"W. II. IIorriiB, Secretary.
57
On the Epidemics of 1846 to 1850.
Appendix A., No. 13.
Order for the Regulation and Management of Temporary Fever
Hospitals.
In pursuance of an Act passed in the 11th and 12th year of the reign of
her present hlajesty, Queen Victoria, entitled “ An Act to amend and con-
tinue until tlie iirst day of November, 1849, and to the end of the then next
Session of Parliament, an Act to make provision for the treatment of poor
persons afflicted with Fever in Ireland,” by which the Commissioners of
Health are empowered to make orders for the regulation and management
of Hospitals provided under the said Act.
Now we, the undersigned Commissioners, do issue the following directions
for the management and regulation of Temporary Fever Hospitals provided
under the said Act : — • • tit
1st. That there shall be kept at every Hospital a Book, in which Mem-
bers of the Visiting Committee, or Board of Guardians, or Managing Com-
mittee are to enter their observations.
2nd That there shall also be kept a Communication Book, m which the
Medical Offleers are to enter their observations on any matters connected
with the management of the Hospital, conduct of attendants, diets, &c.
The Commissioners of Health recommend that, in every case, a Committee
should be appointed, as provided for by Clause V. of 12 Vic., c. 131, and
that one or more of the Committee should undertake the duty of frequently
visiting and inspecting the Hospital in turn, particularly at the patients’
meal times.
Medical Attendance.
1st That the Medical Officer shall visit the Hospital every day before
the hour of 12 o’clock, and enter his name and horn- of visit in a Signatiu'c
Book.
2nd. — That the provisions of the following clause be strictly enforced,
which prohibits, under a penalty, any Member of Board of Guardians, Com-
mittee, or any Paid Officer, from supplying medicine, medical appliances, or
any article whatever required for the Hospitals : —
“And be it enacted. That no Guardian, Paid Officer, Member of any
Committee under the said recited Acts or either of them, or this Act, or
other person in whose hands the providing for, ordering, management, con-
trol, or direction of any Hospital or Dispensary, or of hledical Belief under
the provisions of this Act, shall or may be placed, shall, cither in his own
name or the name of any other person, provide, furnish, or supply, for his
own profit, any materials, goods, or provisions, for the use of any snch llos-
pitid or Dispensary, or for affording such Medical Belief during the time for
which he or they shall retain such appointment, nor shall be concerned, for
his own profit, directly or indirectly, in furnishing or supplying the same, or
in any contract relating thereto, under jiain of forfeiting the sum of fifty
pounds, with full costs of suit, to any jierson who shall sue for the same by
action of debt, or on the case in .any of her IMajesty’s Courts of Becord at
Dublin.” [Sec. 10, 12 Vic., c. 131.]
3rd — That, unle.ss in special cases to be determined by the Board of
Health, and on application to them, the Medical Officer who prescribes for
the patients shall not compound the j)rcscri[)tions, or perform the usual duties
of ail Apothecary.
4th._That the Prescription Book used at the Hospital be of the form
herewith sent, and that the Prescription Book shall be lu-cserved.
5th — Unit the medicine recpiired for the use of the Hospital bo pur-
chased on the order of the Board of Guardians, or Hospital Committee,
according to the list herewith sent, and that the quantities procured for the
use qt the Hospital, showing each month’s consumption, bo entered in the
Medicine Book, a copy of which is herewith sent.
Cth. — That the Clerk of the Board of Guai'dlaus, or of the Hospital Com-
58
Report of the Commissioners of Health, Ireland,
inittee transmit, on the first Monday in every month, to the Board of Health,
a list of the medicines and medical appliances used, with the prices annexed,
and the name and residence of the person or persons from whom such medi-
cine or medical appliances have been procured.
7 th — That the Apothecary either reside at the Hospital, or in its immediate
neighbourhood, and that the medicines procured as above, be compounded
by liirn, but that he is not to supply the medicine which he compounds.
(Vide cl. 10 of 12 Vic., c. 131, as above.)
8 th — That a copy of the accompanying Table, (Hospital Weekly Retmm)
properly filled up, be transmitted weekly to the Board of Health, signed by
the Medical Officer, or Registrar.
9th — That a book, eorresponding with the accompanying form, showing
the names, residences of the patients, nature of the cases, and the results, be
kept and preserved for inspection in each Hospital. ^
Nurses, Servants, &c.
1st — That every Nurse employed be able to read and •write.
2nd — That the Nurses and Servants employed in and about the Hospitals
receive liberal rations, as part of their wages. This rule should be strictly
adhered to, otherwise the attendants will lose time in providing and pre-
paring their own meals ; and they wiU, moreover, be exposed to the tempta-
tion of encroaching on the patients’ food.
Patients.
1st — Thrtt there shall be a separate bedstead for every patient.
2nd. — That every patient, on admission, shall be provided -with a straw
bed in sacking, two sheets, two blankets, a rug, pillow, and night-shirt.
3rd — ^That the night-shirts, and sheets, and the straw, shall be changed
on every Thursday in each week, and oftener if soiled.
4th — That the straw shall be changed for each new patient.
5th — That the wards be swept every day, and kept clean principally by
dry scrubbing.
6th — That the hour for Breakfast be 9 o’clock. Dinner 1 o’clock, and
Supper 6 o’clock.
7th That the following shall bo the dietary of the Hospital, and that it
shall not be departed from, unless on special application to the Board of
Health, and with their sanction.
Dietary for Temporary Fever Hospitals under the Temporary Fever
Acts, 9 Vic., c. 6; 10 Vic., c. 22; and 12 Vic., c. 131.
liow Diet,
(l^.)
Middle Diet.
(M.)
Full DieL
(F.)
Kicc Diet.
(R.)
Breakkast,
Three pints of
Whoy ill
Twenty-four
Hours.
4 oz. Broad,
1 pint Now Milk.
6 oz. Bread,
1 pint New Milk.
6 oz. Bread,
1 pint New Milk.
Dinner, . .
4 oz. Bread,
1 pint Beef Tea.
8 oz. Bread,
1 lb. boiled BeeforMut-
ton, without bone,
1 pint of Broth.
4 oz. Broad,
1 pint Hicc Milk.
Supper, . .
4 oz. Bread,
1 pint New Milk.
4 oz. Bread,
1 pint New Milk.
4 oz. Bread,
1 pint New Milk.
The Meat and Broth in Full Diets to be given on five days in each week; on Wednesdays
and Fridays 1;| pint of Milk Gruel to be sub.stitutcd for the Meat and Broth at dinner.
Cliildren from five to ten years of age to have half the above quantities; above ten years of
ago to bo allowed the full quantities.
( Arrow Root, allowed only for Patients on Low Diet.
) 'Wine on Low, Aliddle, or Rice Diet.
EXTRAS.
) Whiskey, .
Porter,.
on Low or Middle Diet.
gii* No Extras to bo alloiced for Patients on Full Diet.
On the Epidemics ^1846 to 1850.
59
FORMS FOR MAICING
BEEP TEA,
, ono gallon.
BHOTH,
one gallon.
Beef cut small, . . . 1 lb.
Pepper, . . . . s oz.
Salt, hoz.
Water, . . . . Ig gal.
Boil for two hours.
Beef, 1 lb.
Potatoes mashed, . . . _T 1 lb.
Or Barley or Rice, . . (. i lb.
Oatmeal, . . '. . a lb.
Onions or Leeks, . . . 2 oz.
Pepper, . . . . r oz.
Salt 1 oz.
Water, .... gal.
Boil for three hours.
BICE MILK,
one gallon.
MILK GRUEL,
ono gallon.
Rice, ' 1 lb.
Sweet Milk, ... 1 gal.
Sugar, . . . . ^ lb.
Boil slowly for an hour.
Oatmeal, , . . . 1 lb.
Sugar, . ■ . . . i lb.
Ginger, . . . . J oz.
Milk, . • . . . 1 qt.
Water, .... 3 qts.
Steep the Meal from night before. Boil
for two hours.
8th That at least one copy of the dietary shall be posted in each Ward
for the information of the patients, and as a check on the attendants’ giving
out the diets.
9th — That, in addition to the ordinary diet drinks, there shall be con-
stantly provided at the bed-side of every patient a porringer of water, and
that there shall be always kept, on each Ward Table, a supply of fresh water.
General Regulations,
Copies of which are to be posted through the Hospital.
Patients, _ able to get up, are to rise before breakfast every morning, to
fold up their own sheets and blankets, and pack them neatly on the foot of
each bed, so as to expose the bed to the air, and to permit a ready inspection.
Those patients, who are sufficiently strong, ai’e to obey the directions of
the nurses, in sweeping out the wards, supplying drinlc to other patients, and
in affording all other reasonable assistance in their power ; they arc not,
however, on any account, to be permitted to take any part in the adminis-
tering of medicines or injections.
No smoking to be permitted in the wards.
No food to be brought in by the friends of patients.
Patients friends to be admitted into the Hospital every day, for one hour,
from 1 to 2 o clock, but at no other times, unless by written direction of the
Medical Officer.
Given under our hands this day
of One Thousand
Eight Hundred and Forty-nine.
■ f Commissioners.
60 Report of the Commissioners of Health, Ireland,
Appendix A., No. 14.
Table showing the order in w'hich Eequisitions were issued for the
provision of Temporary Fever Hospitals and Dispensaries.
Union.
Electoral Division'^
or place named for Hospital,
or Dispensary, to bo
jirovided at
Date of Requisition.
Tullamore,
Tullamore,
26th February’’, 1847.
Pcrniov,
Mitchelstown, .
3rd March, ,,
Carrick-on-Suir,
Portlaw,
17th ,, ,,
Atli3% .
Ballylinan,
19th ,, „
Hoseommon,
Roseommon,
Baltinglass,
Baltinglass,
24th „
Monaghan,
Castleshane,
29th „ ,,
Kilmore,
Ballina,
Kilcommon,
5th April, ,,
Binghamstown,
99 99
Carrick-on-Suir,
Carrick-on-Suir,
14th ,, ,,
Cavan, .
Bclturbet,
9 ) 9 9 9 >
Lisnaskea,
Derrylin,
9 9 .9 9 9 9
Mallow,
Doneraile,
99 99 99
Monanimj',
99 99 99
Dundalk,
Carlingford,
19th ,, ,,
Fermoy,
Castlelyons,
99 99 99
Rathcorinac,
Castletownroche,
) > 99 99
Kilworth,
99 99 99
Bally bool}'’.
99 99 39
Bandon,
Bandon,
4th May,
Dublin, North,
North City,
33 93 33
Dublin, South,
South City,
33 33 33
Mallow,
Mallow,
33 33 33
Bantry,
Bantry,
itll ;s
Castletown Berehavcn,
33 33 33
Cashel, .
Eethard,
33 33 33
Dungarvan,
Dungarvan,
33 33 33
Aglish,
33 33 33
Bonmahon,
33 33 33
Ivilinallock,
Kilinallock,
33 33 33
Bruff, .
3 3 * 3 3 3
Killinan,
3 3 3 3 3 3
Macroom,
Ov.ans, .
33 33 33
Agliabulloguc, .
33 33 33
lUagourncy,
33 33 93
Midlcton,
Youghal,
33 33 33
Castlemartyr, .
93 33 33
Killeigh,
33 33 33
Midleton,
33 33 33
Lisgood,
33 33 33
Dungourncy, •
33 33 33
Clovnc,
33 33 33
ScnrilF, .
ScaritF, .
33 33 33
Killaloc,
3 3 * 3 3 3
Tulla, .
3 3 3 3 3 3
Tralee, .
Tralee, .
33 33 33
Waterford,
Trim,
Waterford,
Seariff Bridge, .
33 33 33
7 til 3 3 3 3
Duumanway, .
Dumnanwa}', .
loth ,,
Feruioy,
Kildorrery,
3 3 3 3 >3
Fermoy,
33 33 33
Kanturk,
Freemount,
33 33 33
On the Epidevrdcs of 1846 to 1850.
61
Union.
Kanlurk,
Armagh,
Ballina,
Boyle, .
Clogheen,
Cork,
Downpatrick,
Enniskillen,
Keninare,
Lurgan, ‘
Nenagh,
Parsonstown,
Eathdrum,
Trim, .
Carlow,
Cashel,
Galway,
Kilkenny,
Armagh,
Athlone,
Ballinasloe,
Clogheen,
Clones,
Dundalk,
Galway,
Kells, .
Kenmare,
Kilmallock,
1 »
Kinsale,
5 >
Lough rea,
Kew Boss,
Eatlidruni,
Bandon,
Caherciveen,
Kenmare,
Limerick,
Lismore,
) >
Londonderry,
Mallow,
Naas, .
Electoral Division,
or placo named for Hospital,
or Dispensary, to bo
provided at
Kanturk,
Keady,
Ballina,
Boyle, .
Clogheen,
Cahir, .
Ballyporeen,
Ardfinnan,
Cork, .
'Whitechurch,
licitlicooiiGy j
Cove, .
Monkstown,
Ballincollig,
Killeagh,
Enniskillen,
Bourdoneen,
Moira, .
Borrisokane,
Uskeaue,
Wicldow,
Trim,
Leighlinbridge
Cashel, .
Oranmore,
Kilkenny,
Gowran,
Johnstown,
Freshford,
Castlecomer,
Thomastown,
Ballyragget,
Loughgall,
Athlone,
Eyrecourt,
Kilbenny,
Eoslea, .
Dundalk,
Killanin,
iloyeullen,
Ouglitcrard,
Spandaw,
Sueem, .
Bruree,
Ballylanders,
Kinsale,
Ballinspittle,
Loughrea,
New Boss,
Bray, .
Clonakilty,
Valentia,
Kenmare,
Limerick,
Templemichacl,
Capj)oquin,
Londonderry,
Buttevant,
Kilcullen,
Date of Requisition.
10th
17 th
May,
19 th
21st
24th
1847.
62 Report of the Commissioners of Health, Ireland,
Union.
Electoral Division,
or place named for Hospital,
or Dispensary, to bo
provided at
Dato of Kcquisition,
Eoscrea,
Sliinrone,
24th
May,
1847.
New Eoss,
Tintern,
25th
Oldeastle,
Virginia,
Bailieborough, .
Bailieborough, .
26 th
9 9
Enniscorthy,
Enniscorthy,
99
99
9 9
Enniskillen,
Swanlinbar,
Gorey, .
Gorey, .
99
9 9
9 }
Kilkeel,
Kilkeel,
Kin sale,
Carrigaline,
9
99
99
Lisburn,
Saintfield,
Eathkeale,
Groom, .
28th
99
Enniscorthy, .
Newtownbarry,
9 9
9 9
Gorey, .
Eord,
9
1 9
9 9
Kells,
KeUs, .
9 9
Lisuaskea,
Brookborough,
9 9
9 9
99
Newry, .
Newry, .
99
99
99
Eoscommon,
Strokestown, .
\
Lanesborough, .
9 9
99
99
Clones, .
Clones, .
29th
9 9
99
Eermoy,
Mogeely,
) )
9 9
9 9
Galway,
Galway,
99
99
99
Kenmare,
Tousist,
9 9
9 9
99
Lismore,
Tallow,
9 9
9 9
99
Macroom,
Macroom,
99
99
99
MohUl, .
Mohill, .
9 9
9 9
9 9
Monaghan,
Monaghan,
9 9
99
99
Dingle,
Dingle, .
1st June,
9 9
Lurgan,
Portadown,
9 9
99
99
ft • •
Lurgan,'
9
9 9
99
Scariff, .
Eeakle,
9 9
9 9
9 9
Sligo, .
Collooney, ■ .
•9
9 9
99
Tbiu'les,
Thurles,
9
99
Ballinrobe,
Ballinrobe,
2nd
9 9
9 9
Banbridge,
Tanderagee,
) 9
9 9
9 9
Calierciveen, .
Drumod,
9
9 9
99
Cloglieen,
Whitechurch, .
9 9
9 9
9 9
Eoscrea,
Killavenogue, .
9
9 9
9 9
Cootehill,
Corgreagh,
3rd
9 9
9 9
Eermoy,
Ardnageehy,
9 9
9 9
9 9
Eathdown,
Eathdown,
9 9
9 9
9 9
Newcastle,
Newcastle,
4 th
9 9
99
Abbeyfeale,
9 9
9 9
9 9
Ballingarry,
9 9
99
99
Killeedy,
9 9
99
99
Skibbereen,
Leap, .
99
99
9 9
Abbeystrowry,
9 »
9 9
99
Tullagh,
) «
99
99
Aghadown,
99
9 9
9 9
99 • •
9 9 • •
>9 •
99 • *
99 • •
Kilmoc,
West Skull,
East Skull,
Caherragh,
Dromdallcaguc,
Eoscarbery,
Tipperary,
Castleisland,
9 >
) )
9
9 9
9 9
9 9
99
99
9 9
99
99
9 9
9 9
9 >
9 9
9 9
Tipperary,
9 9
99
99
'J’ralce,
9 9
5th
99
99
Eoscrea,
Dunkerrin,
99
9 9
Banbridge, '
Dromorc,
8th
9 9
9 9
Callan,
Mullinahono, .
99
99
99
On the Epidemics of 1846 io 1850
63
Union.
Electoral Division,
or place named for Hospital,
or Dispensary, to bo
provided at
Bate of Boquisition.
C.orlow,
Borris, .
8 th June, 1847.
Granard,
Drumlumman,
Macroom,
Matehy,
Mallow,
Ballinamona,
New Eoss,
Dunbrody,
Eathkeale,
Eathkeale,
Tuam, .
Tuam, .
Waterford,
Mulliuavat,
Carrickmacross,
Carrickmacross,
loth ,, ,,
J) • •
Eaferagh,
J 1 • •
Oootehill,
Kanturk,
Donaghmoyne,
Drum, .
Newmarket,
99 99 99
99 99 99
Kenmare,
Naas,
Bandon,
99 • •
Downpatrick, .
Ballybog,
Naas,
Iniskeeu,
Innishannon, .
Ballynahinch, .
99 99 99
f 99 99 99
11th „
99 99 99
Dungannon,
• •
Tullyniskin,
Moy, .
99 99 99
99 • •
Dungannon,
9 9 •
Mountmellick, .
New Eoss,
Donaghmore, .
Mountrath,
Eethard,
99 99 99
12th „
Eathdown,
Tipperary,
Waterford,
Kingstown,
Cullen, .
Kilmacthomas,
”
99 99 99
99 99 99
Carlow,
Shillelagh,
Ballon, .
Hacketstown, .
14th ,,
Armagh,
99 • •
) ) •
Armagh,
Markethill,
Middletown,
15th „
99 99 *99
Omagh,
Drumquin,
Cashel,
Lisburn,
Limerick,
99 • •
99 • .
ICillenaule,
Hillsborough, .
Castleconnell, .
Cappamore,
Caherconlish, .
icth
99 )> ,,
18th „ ,,
99 99
Glentics,
Ballymoney,
Dungloe,
Kilrea, .
99 99 99
19th „
Enniskillen,
99 • .
Clabby,
Lisbellaw,
99 H
99 9, ,,
Limerick,
Kilbane,
99 ,9
99 • .
Listowel,
Abington,
Listowel,
” )> 99
99 99 ,,
Midleton,
Garr3''voe,
” j> ))
Eathdruin,
Newcastle,
” ” ),
Eoscrea,
Bourney,
” >» j,
Parsonstown, .
Trim, .
Parsonstown, .
Athboy,
” , >> >,
22nd ,,
Ballinasloc,
Manorhamilton,
Carnacregg,
Manorhamilton,
99 99 99
23rd „
Nenagh,
Cloghjordan, .
99 99 9,
99 •
Nenagh,-
99 99 99 1
«« •• 1
99 * • •
'Toomavarra,
5 J >> ) 9
99 • •
Si 1 verm hies,
99 99 ,,
99 •
99 • •
Newport,
Portrue,
99 99 ,,
” 99
Cork, .
Inniscarra,
99 J> ,,
24th „
64 Report of the Commissioners of Health, Ireland,
Union.
Electoral Division,
or place named for Hospital,
or Dispensary, to bo
provided at
Date of Requisition.
Hoscrea,
Aghancon,
24th June, 1847.
Borris-in-Ossory,
99 99 99
Cavan,
Ballyhaise,
25 th „
9 J • •
Crossdoney,
99 99 99
Belturbet,
9 9 • •
Bally machugh,
99 99 99
Stradone,
Killashandra, .
Clones, .
Newtownbutler,
Granard,
Gran.ard,
New Ross,
Graigue,
Carrick-on-Shannon, .
Carrick-on-Shannon, .
26 th „
Magherafelt,
Magherafelt,
99 99 99
Omagh,
Omagh,
99 99 99
Sligo, .
Toberenrry,
99 99 99
Calierciveen, .
Caherciveen, .
29th „
Callan, .
Callan, .
99 99 99
Kantiirk,
Kilmeen,
99 99 99
Kenmare,
Kilgarvan,
99 99 99
Kilmallock,
Glenroe,
99 99 99
Parsonstown, .
Kinnety,
99 99 99
Bailiehorough, .
Kingseourt,
30 th ,, ,,
Thurles,
Templemore, .
99 99 99
Oldcastle,
Castlepollard, .
1st July, ,,
Enniscorthy,
Killan, .
2nd ,, „
AVexford,
Wexford,
99 99 99
Clogher,
Aughnacloy,
3rd ,, „
Cootehill,
Cootehill,
5th ,, ,,
Killarney,
Killarney,
99 99 99
Ballinrobe,
Kilmain,
6tll yy
Omagh,
Dromore,
99 99 99
Casliel, .
Knockgrafifon, .
/til yy yy
Omagh,
Eintona,
99 99 99
Parsonstown, .
Lorha, .
9 9 9 9 9 9
Caherciveen, .
Glenbeigh,
8th ,, ,,
Downpatrick, .
Ardkeen,
99 99 99
Monaghan,
Emyvale,
99 99 99
Trim, .
Summerhill,
99 99 99
Ballina,
Easky, .
9tll yy yy
Droglieda,
Drogheda,
99 99 99
Abbeyleix,
Bally roan.
10th ,, ,,
Banbridge,
Loughbrickland,
99 99 99
Kinsale,
Nohoval,
99 99 >9
Lowtherstown,
Lowtherstown,
99 99 99
Westport,
Balrothery,
W estjjort,
Balbriggan,
99 99 99
12th ,,
Enniscorthy, .
Clonroche,
99 99 99
Navan, .
Navan, .
99 99 99
Tipperary,
Golden,
99 99 99
Caj-low,
Doonane,
13tll 99
Louglirca,
Athenry,
9) 99 99
New Ross,
Rosbercon,
99 99 99
Clifden,
Ballindoon,
14th „
Kanturk,
Millstreet,
15th „
Roscrea,
Rathdowney, .
9 9 9 99
Tipperary,
Cappawhitc,
99 y» 99
Ballina,
Crossmolina,
IGtll yy 99
Ballinasloe,
Mountevans,
99 91 99
Ballyshannon, .
Ballyshannon, .
99 99 99
On the Epidemics of 1846 to 1850.
65
Electoral Division,
or place named for Hospital,
or Dispensary, to bo
Union.
Date of Requisition.
—
provided at
Castlerea,
Gort,
Athy, .
Longford,
Ardee, .
Ballinasloe,
Granard,
Magherafelt,
> ♦
Dungarvan,
Loughrea,
Ballinasloe,
Ballinrobe,
> >
Longford,
Castlerea,
Clogher,
Gort, .
Ballinrobe,
>)
Roscommon,
Castlerea,
Eathdrum,
Clifden,
Enniskillen,
Granard,
Ennistymon,
Kilrush,
Oldcastle,
» »
CookstoTvn,
Navan, .
Galway,
Longford,
Ratbkeale,
Castlebar,
Mullingar,
New Ross,
Tuam, .
Ballinrobe,
Ballinasloe,
Kilmallock,
Dingle, .
Belfast,
Lisburn,
Clifden,
Naas,
> y
Bailieborougli,
Carlow,
Mohill, .
) I
Boyle, .
Clbfden,
yy
Ballina,
CaLlan, .
Kilkerrin,
Ivinvarra,
Athy, .
Eathcline,
Ardee, .
Ahascragli,
Street, .
Bellaghy,
Moneymore,
Clashmore,
Portumna,
Aughrim,
Claremorris,
Partry,
Tarmonbarry,
Ballyhaunis,
Ballinlougb,
Erenchpark,
Eivemiletown,
Gort,
Ross,
Churchfleld,
Knockroghery
Glannamodda,
Roundwood,
Roundstone,
Killinagh,
Coole, .
Miltownmalbay
Kilrush,
Crossakeel,
Ballyjamesdufif
Pomeroy,
Ardbraccan,
Waterdale,
Clonaugh,
Askeaton,
Addergoole,
Mullingar,
Innistiogue,
Monivea,
Neal,
Kilconnell,
Charleville,
Castlegregory,
Belfast,
Lisburn,
Clifden,
Robertstown,
Blessinton,
Shercock,
Tullow,
Ballinamore,
Carrigallen,
Coolavin,
Ballinahinch,
Ballinakill,
Belmullet,
Kilinaganny,
16th July, 1847.
yy yy yy
1 / til yy ) )
»> yy yy
19th ,, „
yy yy yy
yy yy yy
yy yy yy
yy yy yy
21st ,, ,,
yy yy yy
23rd „ ,,
24th „
28th „
yy yy yy
29th ,, ,,
yy yy yy
31st „ „
yy yy yy
yy yy yy
2nd August, ,,
yy yy
6th ,,
yy yy
7th ,,
yy yy
9th ,,
yy yy
yy yy
yy yy
10th ,,
yy yy
nth ,,
” >>
12 th „
23rd „
26 th „
28th „
2nd September, , ,
^th „
23rd „
13th November, ,,
>> '> )>
16th ,,
yy yy I)
15th December, ,,
yy yy yy
1 / III ,, ,,
31st ,, ,,
” >> j)
6th January, 1848.
6th „
>> >>
18th „
>> >»
F
66 Rc'port of the Commissioners of Health, Ireland,
Union.
Electoral Division,
or place named for H( apital,
or Dispensary, to bo
provided at
Date of Requisition.
Carlow,
Bagnalstown, .
18th January, 1848.
Manorhainilton,
Drumkeeran, .
19th „
Parsonstown, .
Frankford,
5 th February, ,,
Ballina,
Killala,
18th ,, ,,
Carlow,
Carlow,
25 th ,, ,,
Ballinasloe,
Ballinasloe,
13th March, ,,
Shillelagh,
Tinnehely, .
23rd ,, „
Enniscorthy,
Oulart, .
5th April, ,,
Carlow,
Ballickmoyler, .
15tli ,,
Ennistymon,
Moymore,
5»
Kilrusli,
(Dispensaries),
26th ,, „
Clifden,
Eoundstone,
22nd May, ,,
Galway,
Annaghdown, .
25tli ,, j,
Ennistymon,
Ballyvaughan,
13 th June, ,,
Tuam, .
Dunmore,
20th July, ,,
Kilrush,
Kilflddaan,
22nd ,, „
Rathkeale,
Shauagolden, .
24th, ,, 9,
Westport,
Bofln, .
17th August, ,,
Cavan, .
Miltown,
9th October, ,,
Ennis, .
Ennis, .
23rd December, ,,
Fermoy,
Ballynoe,
21st April, 1849.
Dingle, .
Annascaul,
14th May, ,,
Scariff, .
Whitegate,
27 th June, ,,
Carrick-on-Shannon, .
Elphin, .
28th July, ,,
Lisnaskea,
Lisnaskea,
17th October, ,,
Appendix A., No. 15.
Summary Returns, sho-wing the Number of Patients treated under the
Temporary Fever Acts in the principal Towns in Ireland.
Year.
Name of Town.
Number
Treated.
Number
Died.
Rate of
Mortality
per cent.
1847
Belfast,
484
44
9-1
Cork, .
3,907
316
8-1
Dublin,
15,357
1,089
7-1
J »
Galway,
1,054
46
4-3
Limerick,
2,429
218 '
8-9
Waterford,
2,446
236
9-6
Total,
•
25,677
1,949
7-5
1848
Belfast,
237
19
8-
Cork, .
■ 1,792
162
9-
Dublin,
9,033
812
9-
>>
Galway,
1,937
136
7*
Limerick,
5,496
848
15-4
>>
Waterford,
1,854
174
9-3
Total,
•
20,349
2,151
10-5
67
On the Epidemics q/’1846 to 1850. ,
Summary Returns, showing the Numberof Patients treated under the Tem-
porary Fever Acts in the principal Towns in Ireland — continued.
Year.
Name of Town,
Number
Treated.
Number
Died.
Hate of
Mortality
per cent.
1849
Cork, ....
4,149
777
18-7
>>
Dublin,
5,481
499
9-1
Galway,
1,123
221
19-6
99
Limerick,
817
235
28-7
99
Waterford,
2,077
127
6-1
Total,
13,647
1,859
13-6
1850
%
Cork, ....
1,803
148
8-2
99
Dublin,
3,748
296
7-9
99
Waterford,
2,184
182
8-3
Total, ,
7,735
626
8-1
1847"
1848
1849
1
Grand Total, as above, ' .
64,127
6,585
10-2
1850
(The number remaining under
treatment on the termination
of the years 1847, 1848, and
1849 deducted.)
[Summary op Returns.
F 2
68
Report of the Commissioners of Health, Ireland,
Appendix
SuMMAKY OF Retuens, sliowing the Number of Patients treated in
Total for all Ireland, with rate of Mortality
PROYINCE OP ULSTER.
PROVINCE OF LEINSTER.
PROVINCE OF
If umber of Patients.
Number of Patients.
Number of
Remaining at the
termination of
previous Month.
Admitted during
the Month.
Total treated.
Discharged cured.
•o
u
P
Remaining under
treatment.
Remaining at the
termination of
previous Month.
1
Admitted during
the Month.
Total treated. I
Discharged cured.j
Died. I
u
V
'O
S J
.ea
c-S
II
«
S
V
SsS
^ G
« 5 o
111
III
1 « £
Admitted during
tiic Month.
"e
o
u
3
o
H
1817.
July,
075
3,519
4,194
1,704
151
2,339
906
5,930
0,842
3,416
185
3,241
3,121
10,619
13,740
August. •
2,339
2,761
5,100
2,636
181
2,283
3;241
5,541
8,782
4,454
298
4,030
5,833
7,593
13,426
Septornber,
2,283
2,200
4,483
2,230
166
2,087
4,030
5,406
9,436
4,801
401
4,234
6,784
5,890
11,674
October, .
2,087
2,337
4,424
3,032
146
1,246
4,234
6,405
10,639
5,966
470
4,203
5,086
5,460
10,346
November,
1,246
1,307
2,553
1,169
107
1,277
4,203
4,046
8,249
4,094
348
3,807
3,920
3,735
7,661
December,
1,277
1,353
2,630
1,112
116
1,402
3,807
3,908
7,715
4,121
409
3,185
3,295
4,222
7.517
1848.
January, .
1,402
1,184
2,586
1,448
134
1,004
3,185
4,015
7,200
3,652
467
3,081
3,530
5,100
8,630
February, .
1,004
973
1,977
875
101
1,001
3,081
2,904
5,985
2,693
324
2,968
3,851
5,416
9,267
March,
1,001
1,062
2,063
854
132
1,077
2,968
3,303
6,271
2,935
327
3,009
4,354
5,802
10,156
A pril.
1,077
1,037
2,114
1,108
148
858
3,009
3,306
6,315
3,188
413
2,714
4,740
7,793
12,533
May,
858
869
1,727
814
84
829
2,714
2,527
5,241
2,451
272
2,518
4,595
6,069
10,664
Juno, - .
829
674
1,503
728
67
708
2,518
2,134
4,652
2,325
203
2,124
4,254
4,440
8,694
July,
708
682
1,390
726
64
600
2,124
2,175
4,299
2,369
204
1,726
4,114
5,226
9,340
August, .
GOO
301
901
403
30
408
1,726
1,476
3,202
1,683
119
1,400
3,592
3,167
6,759
September,
408
263
071
377
19
275
1,400
1,768
3,168
1,961
129
1,078
3,039
3,164
6,203
October, .
275
128
403
216
23
164
1,078
1,209
2,287
1,192
85
1,010
2,395
2.152
4,547
November,
164
90
254
97
17
140
1,010
1,282
2,292
1,044
118
1,130
2,259
2,24G
4,505
Docomber,
140
207
347
140
24
183
1,130
1,495
2,625
1,366
147
1,112
2,104
3,150
5,254
1849.
Januarv, .
183
321
504
143
63
298
1,112
1.572
2,684
1,238
139
1,307
2,247
3,085
5,332
February,
298
343
641
189
70
382
1,307
1,860
3,167
1,439
205
1,523
2,591
3,914
G,505
382
523
905
359
in
435
1,523
2,509
4,032
1,976
379
1,677
2,942
4,913
<,855
435
399
834
303
111
360
1,677
1,947
3,624
1,764
316
1,544
2,965
4,179
7,144
360
325
685
309
72
304
1,544
2,170
3,714
1,756
349
1,609
3,045
4,566
7,611
304
251
655
241
85
229
1,009
2,728
4,337
2,179
384
1,774
2,984
5,860
8,844
229
213
442
193
28
221
1,774
1,855
3,629
1.829
249
1,551
3,110
3,570
G,G85
221
207
428
186
27
215
1,551
1,558
3,109
1,633
189
1,287
2,828
3,406
6,234
215
290
505
261
18
226
1,287
1,800
3,147
1,763
179
1,205
2,517
3,3/4
5,891
226
164
390
156
27
207
1,206
1,352
2,557
1,250
127
1,174
2,201
2,482
4,6b3
207
172
379
154
18
207
1,174
1.297
2,471
1,161
115
1,195
2,188
2,249
4,43/
Decomber,
207
257
464
227
31
206
1,195
1,G55
2,850
1,597
127
1,126
2,124
2,671
4,795
1850.
206
188
394
153
22
219
1,120
1,490
2,610
1,131
144
1,341
1,940
2,349
4,289
219
257
476
189
27
260
1,341
1,449
2,790
1,340
138
1,312
2,032
2,592
4,G24
260
304
564
257
57
250
1,312
1,898
.3,210
1,737
205
1,268
2,040
3,4 iG
5,45G
250
230
480
197
52
231
1,268
I, ,549
2,817
1,359
160
1,298
2,080
2,709
4,789
231
168
399
192
35
172
1,298
1,011
2,909
1,4.55
160
1,294
1,985
3,001
4,986
Tn'n'n
172
262
434
174
38
222
1,294
1,819
3,143
1,753
182
1,208
2,168
3,4U4
5,572
222
157
379
191
15
173
1,208
1,510
2,718
1.367
139
1,212
1,990
2,420
4,4 U>
August, .
173
81
254
112
10
132
1,212
981
2,193
1,014
79
1,100
1,913
1,431
3,844
Totals, .
23,373
if
49,1.13
23,976
2,937
2S,U30
7fl»30l
no.MJO
160,017
U4,458
8,804
73»5/5
117,782.166,840
274,608
On the Epidemics <?/’1846 to 1850
69
A., No. IG.
Temporary Fever Hospitals, per Montli, in each Province, and the
(luring the Years 1847, 1848, 1849, and 1850, respectively.
MUNSTER.
PROVINCE OF CONNAUGHT.
Number of Patients.
Discharged cured .
•3
s
u
tJ
1-
ft)
ti
Eem.Tiningatthe
terniiiintinn of
previous Month.
Admitted during
the Month.
Total treated.
'C
u
s
Cl
*3
Cl
tl)
a
JS
5
7,297
610
5,833
172
1,27S
1,450
779
7,097
545
5,78<
619
1,788
2,407
1,133
6,102
486
5,08(]
1,201
1.462
2,663
1,312
0,213
407
3,920
1,258
1,661
2,919
1,995
•l.ODG
300
3,295
838
1.48(
2,318
1,223
3,676
311
3,530
1,031
1,109
2,140
1,100
•1,259
520
3,851
980
2,033
3,013
1,537
•1,370
543
4,354
1,311
1,506
2.817
1,398
4,762
C54
4,740
1,283
2,004
3,287
1,720
7,100
838
4,595
1,342
2.773
4,115
2,160
5,850
560
4,254
1.075
3,507
5,182
3,828
•1,122
458
4,114
1,121
1,350
2,471
1,113
5,289
459
3,592
1,229
1,801
3,030
1.502
3,387
333
3,039
1,392
1,100
2,501
1,177
3,528
280
2,395
1,215
1.520
2,735
1,415
2,072
216
2,259
1.211
1,142
2,353
1,169
2,184
217
2,104
1,102
1,165
2,267
1.017
2,610
397
2,217
1,134
1,682
2,816
1,309
2,292
449
2,591
1,300
1,516
2,816
1,227
3,028
535
2,942
1,378
1,929
3,307
1,550
3,967
923
2,965
1,480
2,418
3,898
1,893
3,210
889
3,045
1,505
1,803
.3,368
1,554
3,722
905
2,984
1,431
2,073
3,504
1,608
4,814
890
3,1 10
1,443
2,204
3,652
1,835
3,368
489
2,828
1,411
1,337
2,748
1,395
3,263
454
2,517
1,126
1,008
2,194
1,103
3,316
374
2.201
890
1,011
1,901
1,006'
2,250
215
2,188
728
655
1,383'
6I9!
2,073
210
2,124
683
483
1,I66|
50Si
2,610
245
1,940
605
530
1,141;
560
1,975
282^
2,032
500
423
1
92.3:
384;
2,292
292
2,040
491
490
081
426i
2 909
407,
2.0S0
492
051
U43,
oin!
2,477
327
1,985
452
620
972
473]
2,490
828
2,108
420
491
920,
444I
3,144
438:
1,990
421
620
1.041
569
2,204'
299'
1,913
400
302
702
455
2,035
1
1.58,
1,151
273
187
400
280
141,453
I?,.™!
115,702
37,017
61,147
45,410
3 S
tc"
5 S
£ «
5 2
E-
TOTAL OF THE FOREGOING.
Number of Patients.
Mr 5
.5 «
C.£ :
li-i
?• « !
= ■5
*5 a
^ o
£5
I o S
£ H
£-
■g o c
o a s
a
52
619
4,874
21,352
26,226
13,190
998
12,032
3-8
73
1,201
1 2,032
17,683
29,715
15,320
1,097
13,298
3-6
93
l,2.5f
13,298
14,958
28,256
14,445
1,146
12,665
4-0
86
838
12,665
15.803
28,528
17,200
1,100
10,213
3-8
64
1,031
10.213
10,568
20,781
10,5.52
8I!1
9,410
3-9
60
980
9,410
10,592
20,002
10,009
896
9,097
4-4
165
1,311
9,097
12,332
21,429
10,896
1,286
9,247
6-0
136
1.28S
9,247
10,799
20,046
9,330
1,104
9,000
5*5
219
1,342
9,600
12,171
21,777
10,277
1,332
10,108
6-1
274
1.075
10,168
14,909
25,077
13,502
1,673
9,842
6 6
233
1,121
9,842
12,972
22,814
12,943
1,149
8,722
5-0
129
1,220
8,722
8, .598
17,320
8,288
857
8,175
4-9
136
1,392
8,175
9,884
18,059
9,886
863
7,310
4-7
109
1,215
7,310
6,053
13,363
6,710
591
6,062
4.4
109
1,211
0,062
6,715
12,777
7,281
537
4,959
4-2
82
1,102
4,9.59
4,031
9,590
4,049
406
4,535
4*2
116
1,134
4,535
4,783
9,318
4,342
468
4,508
5-0
207
1,300
4,508
6,534
11,042
5,425
775
4,842
7-0
211
1,378
4,842
6,494
11,330
4,900
862
5,,574
7-6
277
1,480
5,574
8,046
13,020
0,206
1.087
6.327
7-9
440
1,565
0,327
10,303
1 0,690
8,195
1,853
6.642
111
383
1,431
0,412
8,328
14,970
6,891
1.099
0,380
113
448
1,448
0,380
9,134
15,514
7,395
1,774
6,345
11-4
406
1,411
6,345
11,043
17,.38S
.9,099
1,765
6,524
101
227
1,126
6,424
0,980
13,504
6,785
993
5,720
7-3
201
890
5,726
6,239
1 1 ,905
0,185
871
4,909
7.2
167
728
4,909
6,535
11,444
6,346
738
4,360
0-4
81
683
4,300
4.0.53
9,013
4,281
480
4,252
6-3
53
605
4,252
4,20)
8,453
3,896
426
4,131
5-0
75
500
4,131
5,119
9,250
5,000
478
3,772
01
48
491
3,772
4.450
8.222
3.643
496
4,083
6-0
t)3
492
4.083
4,788
8,871
4.247
.520
4,104
5*8
75
452
4,104
0,209
10,373
5.519
804
4,050
7-7
70
429
4,050
.5,008
9,058
4,.506
600
6.043
6-7
55
421
3.943
5,271
9.214'
4, .581
578
4.055
6-2
72
400
4.0.-).-,:
6,135
lO.l.O'll
5,610
7MO
3.820
7*1
•n,
273
.3,8>0'
4.455
8.275:
4,217
487
3,571
5*8
19
161
3.571
2,680
6.25I
3,44 1
206
2, 5 4 4
4*2
6,740
1
07,000
I
327,600
670,7^1
sn.s.hio
to Report of the Commissioners of Health, Ireland,
Appendix B., No. 1.
Central Board of Health.
As there seems reason to apprehend that Cholera may again, perhaps
within a short period, reach this country, the Commissioners of Health
deem it advisable to submit, for general information, the following observa-
tions in reference to the epidemic, and to the measures proper to be adopted
in the event of its re-appearance in this country.
The Commissioners of Health are anxious to impress upon all persons the
important difference that exists between Cholera and Fever, with respect to
the mode of propagation of these epidemic diseases. Fever, it is w'ell known,
is highly contagious, or easily propagated from one individual to another,
while all experience shows that Cholera is rarely, if ever, contagious ; con-
sequently, the separation of the sick from the healthy — a measure so essential
in checking the spread of Fever — is not required in Cholera, and the friends
and relatives of persons attacked with Cholera may be under no apprehen-
sion of catching the disease, and need not be deterred from affording to the
sick, in their own dwellings, every needful assistance and attention.
This view of the subject has an important bearing upon the measures to
be adopted in meeting a visitation of Cholera. In contending against epi-
demic Fevers, it has been found necessary to maintain large Hospital
Establishments for the purpose of preventing the spread of the disease by
infection, and of affording to the sick those attentions which are so often
required during the tedious recovery from Fever; but the case is different
with respect to Cholera, and the Commissioners of Health, after mature con-
sideration, do not advise that Cholera should be met by an extended system
of Hospital accommodation, such as is needful in epidemics of Fever, but
recommend in preference, a general system of prompt and efficient Dispen-
sary relief, for the following reasons : —
Istly That Cholera being rarely, if ever, contagious, there is not risk of
infection, as in Fever, in leaving the sick in their own dwellings, or in re-
ceiving them into General Hospitals,
2ndly That an attack of Cholera being usually so sudden, and its whole
duration so short, the delay, necessarily attendant upon the removal of the
patient to Flospital, may lead to loss of life, or of the time most valuable for
treatment.
3rdly That the Medical treatment of Cholera, being much more simple
than that of Fever, can be efficiently conducted at the dwellings of the
patients, and the required assistance to Medical treatment can be as effec-
tively given by the families and friends of the sick, as by nurses in Hospitals.
4tlily That recovery from Cholera not being ordinarily followed by
prolonged debility, (such as attends on Fever,") patients on their recovery
from an attack of Cholera do not generally stand in need of the same length-
ened Hospital attendance .as Fever Patients.
'J'lic Commissioners of Health do not, however, .advise, that in the event
of the appear.ance of Cholera, Hospital relief should be altogether dispensed
with, as there is .always, particularly in cities, a large class of destitute per-
sons who have neither friends nor the means of support, and to such persons
efficient relief cannot be .afforded except in Hospitals. The non-contagious
character of Cholera fortunately removes all objection to the receiving of
persons sufl’erlng under the disease into the ordin.ary Hospitals of the coun-
Iry, whether County Infirmaries or Fever Hospitals, all of which the Com-
missioners of Health .advise should be open and in readiness to receive
destitute patients in Cholera.
'I'he Commissioners of Health believe, th.at besides the adv.antage of afford-
ing prompt and eflieient relief to destitute persons affected with Cholera, the
admission of sueh patients into the ordin.ary Hospitals of the country would
be attended with salutary moral effects. It w'ould greatly lessen, if not
quite remove, the generally prevailing apprehensions respecting the highly
On the E^ndemics of 184:6 to 1850.
contagious nature of tlie disease, and would thus dispose the fi-iends and
rehatives of the sick to be more active .and constant in their attentions ; the
sick themselves no longer treated like persons stricken by a pestilence, would
acquire confidence, and with confidence a strength that would enable them
the better to struggle with the disease.
Nature of the Attack It seems to be a well-established fact, and one that
cannot be too strongly impressed upon the minds of the people generally, as
upon this fact depends the best hope of successfully contending with the dis-
ease, that in nearly all cases of Cholera, there are two stages of the disease,
the first being merely Diarrhma, or simple looseness of the bowels ; the
second being the stage of Collapse, or Blue Cholera, m.arked by cramps,
failure of the circulation, lividity of the skin, cold, clammy perspiration, and
all other well-known symptoms of the disease. In the first stage of the dis-
ease medical treatment is frequently successful, in the second stage too often
of no avail.
'I’he first stage. Diarrhoea, or mere looseness of the hoicels, m,ay be of only
a few hours’ duration, or may continue from one to several da}'S. It is most
important to bear in mind that this Diari hcea 7uay he entirely without pain;
indeed, it most frequently is without pain, ormerely accompanied with trifling
griping or uneasiness. This absence of pain, or the little accomp.anying
uneasiness, has too often thrown the patient off his guard, who has thus
neglected the warning of his danger, and has allowed'the time for cure to
pass by.
It may be safely asserted, that during the prevalence of an epidemic of
Cholera, Diarrhoea, or looseness of bowels, which is free fi-om pain, is more
dangerous, more likely to be the first stage of the disease, than Diarrhoea
accompfinied with griping or pain. Let it then be clearly understood, that
when the epidemic is prevalent, mere looseness of the bowels with or without
pain, may he the commencement or first stage of Cholera — that the disease is
generally curable in this stage, and that not a moment should he lost in annlu-
ing for relief.
To afford this immedi.ate relief, the Commissioners of Health recommend
that every existing Medical Institution, whether Hospital or Dispensmy,
should be open, day and night, during the prevalence of Cholera, to all ap-
plicants, without distinction, where all who apply should obtain, without a
moment's delay, advice and medicine ; .and from which all the poor, who may
be unable to leave their dwellings, m.ay be visited with promptitude, and
suj^lied with medicine .at home, or transferred, if requisite, to Ho.spital'.
To effect these objects the following .arrangements are recommended •
lstl;sa The prescribing room of every Mcdlc.al Institution, whether Hospi-
tal or Dispensary, should be open day and night, without intermission, duriim
the prevalence of Cholera, and a Medical Officer should be in constant
attendance to prescribe for all applic.ants.
2ndly. Each Ho.spital and Dispensary should have a cert.ain district allotted
to It, and the attending Porter or Clerk should keep a book in which he should
enter the names and residences of all applicants for relief within the district,
who are unable to leave their homes. The book sliould show the time of
application, and the name and residence of the patient
second Medical Officer should be constantly in readiness to
receive the mimes of all such .applicants, .and to proceed, without .lel.av, to
rMirlonnr f physicuin, inste.ad of writing a prescription at the
residence of the patient, .should be provided with a small poitlible pocket-
such a form .as to render their administration .as speedy and as simple ns
possible. Such portable medicinc-boxes can be procured at a very small
cost,_or maybcmade up on an emergency of p.astcboard, or thin board or
4 ixelies bro.ad, and 1 inch
eep, with one of the sides to fold h.ack, or open on hinges. I'lm .services of
Apothec.ary will be required to keep up a constant supply of the mcdioincs
72 Beportofthe Commissioners of Health, Ireland,
required, made up ready for use. The Medical Officers ■will generally give
formula} for the medicines they may deem best. The following may, however,
serve as an example of what should be generally provided in the pocket-
medicine-boxes. The most portable forms for the medicines arc selected;
the directions should, as far as practicable, be-printed.
Powders — Carbonate of Ammonia, in waxed papers, each paper contain-
ing 40 grains, and having a printed label on the outside: — “ Curhoimte of
Ammonia — Dissolve this Powder in half a pint of water, give two table spoon-
falls every hour."
Powders — Compound Powder of Chalk with Opium — (Pzilv. Cretw c Opio,)
in packets, each containing 6 papers, each paper containing 10 grains of the
Powder, with a printed label on each packet : — “ Compound Powder of Chalk
loith Opium, One Powder every half-hour until the looseness ceases."
Piles of Powdered Opium, each containing one quarter of a grain of
Opium, and two grains of Powdered Ginger, made up with Oil of Pepper-
mint. The Pills to be in boxes, each box containing 6 Pills, with a printed
label : — “ Opium Pills, one every half-hour until the looseness ceases.”
Pills of Alercury and Opium, each containing one quarter of a gi’ain of
Calomel, two grains of Hydrargyrum c Greta Mercury with Chalk,) and a
quarter of a grain of Opium, made up with Oil of Caraway, (which -will
serve to distinguish them from the plain Opium Pills,) in boxes, each con-
taining 6 Pills, with a printed label : — “ Mercury and Opium Pills, ono
every half-hour.”
Bottles (with cork stoppers).
Half ounce ( 1. Contaming — Tincture of Opium (Laudanum),
Bottles, 1 2. „ Creasote,
One ounce J 3. „ Tincture of Rhatany,
Bottles. 1 4. „ lioQ'man’s Liquor.
Along with the box should be carried a small jar of strong bro'wn mustard.
The Visiting Physicians should also be furnished with printed Forms,
for the removal to Hospital, of patients who are destitute of assistance in
their own dwellings ; — m short, every measure should be adopted that will
obviate the least dela)'. It may be necessary in some instances to establish
Temporary District Dispensaries, but it is most desirable, for reasons already
given, that the permanent institutions should be first made available.
It is not within the purpose of a communication such as this to go into
details of treatment. Tliere are, however, two points on which the Commis-
sioners of Health feel it will not be out of place to give an opinion, viz., the
employment of frictions and the allowance of drinks to the sick. The Com-
missioners cannot recommend that fiuid applications of any kind should be
employed in frictions on the body or limbs, as the cold conscejuent on pro-
longed exposure and evaporation more than counterbalances any supposcl
good effect from friction, which, if at all used, should be made merely with
the warm hand without distiuhing the bed-clothes. The Commissionci's al.-^o
advise that when patients siilFcr from thirst, they should in general be per-
mitted to drink freely, as experience shows that the denial of drink does not
chock vomiting, while it increases very much the sulfering of the patient from
the burning thirst that so often accompanies the disease.
It is scarcely necessary to observe that, as far as empowered by Act of
Parliament, the Commissioners of Health will afford all the co-operation and
advice in their power to Managing Committees of Public Institutions, and to
Voluntary Sanitary Associations, whose aid may be most useful in carrving
out the above measures. To fix the necessary precautions and instructions
in the minds of the ])eople, it is recommeuded that copies of the folloiying
Circular be printed and e.xtensively published and posted under the directions
of the Local Committees.
73
On the Epidemics (^1846 to 1850.
Precautions and Instructions from Commissioners of Health.
Shun dump and low situations, and if possible, quit dwellings in such
places, during the prevalence of Cliolera ; keep your houses and rooms dry,
and the windows and doors open as much and as long as the weather will
permit ; there can scarcely be too much ventilation. An abundant supply
of fresh air is as nccessarj'' during the night as in the day, and pure air is as
requisite for the support of life and health as good food.
Remove all stagnant water and dung heaps from around your dwellings,
and clean out all sewers without delay. Do these things .at once, without
waiting for the outbreak of the disease. It will be unsate, and it will be too
late to”undertake them when Cholera shall have broken out.
Avoid chills ; do not wear wet clothes a moment longer than can be avoided.
Wear a flannel belt round the stomach and loins — make use of plain whole-
some food, in the solid rather than in the liquid form — abstain from fruit,
raw and ill-cooked vegetables, pastry, smoked and hard salted meats, and
salted fish, pork, cider, sttile or sour malt drinks, pickles, and all ai'ticles of
diet that from experience ai-e known to have a purgative effect.
Avoid purgative medicines, particularly Castor Oil, Seidlitz Powders, and
Salts.
Be very careful that the water used as drink is of good quality.
Abstain from stimulants unless prescribed as remedies under medical
advice. In former visitations of Cholera many persons, both rich and poor,
resorted to the use of stimulants — wine, whiskey, brandy, &e., under the false
impression, that what was sometimes useful as a cure, was also good as a
preventive. This is a great error ; stimulants, frequently taken, or taken
in excess, are followed by collapse, which predisposes to the disease, and the
generiil health, moreover, is seriously and permanently injured by the prac-
tice. In fine, shun damp places, particularly for sleeping ; breathe pure air ;
observe cleanliness ; keep the surface of the body warm ; avoid fatigues, and
excesses of .all kinds ; use wholesome plain food ; live temperately ; preserve,
{IS much as possible, a state of general good health, and you will have adopted
the best safeguards against Cholera.
Notice.
1st. If {xttacked by Diarrhcca or looseness of the bowels, however slight,
whether with or without pain, apply without a moment’s delay, at the
Dispensary in where medical relief will be given at any
hour of the day or night.
2nd. Let notice be given without delay, at any hour of the day or night,
.at the same place, of the name and residence of .any p.atient affected with
vomiting, purging, or cramps, who may be unable to go out ; immediate
attendiince will be given, and, if necessary, the patient will be removed to
hospital.
Should you be attacked with Di.arrhoea or looseness of the bowels, with or
without pain, and that medical advice is not !it h.and, go at once to bed,
wrap yourself in warm blankets, roll a swathe ofw.arm flannel, sprinkled with
hot spirits of turpentine, or whiskey, closely round the body, extending from the
chest to the hips, and take a teaspoonful of brandy or whiskey in a little
water, with fifteen drops of laudanum, repe.ating it every hour, if the .attack
be not checked, until a third dose has been taken, but do not venture further
in the use of laudanum without medical advice.
By Order of the Commissioners,
'W , II. IIoFi’ER, Secretary. ■
Central Board of Health, Dublin^
1st September, 1848.
74 Report of the Commissioners of Health, Ireland,
Appendix B., No. 2.
To the Councils <and other Governing Bodies of Cities and Boroughs ;
Commissioners under Local Acts ; the Officers of Health appointed in
pursuance of the Provisions of the Act 59 George 3, Cap. 41, the Trustees,
County Surveyors and others, by Law intrusted Avitli the care and ma-
nagement of Streets and Public Ways and Places in Ireland ; the Guar-
dians of the Poor of the several Unions in Ireland ; the Owners and
Occupiers of Houses, Dwellings, Churches, Buildings and Places of Assem-
bly, and others having the care and ordering thereof; And to all whom it
may concern.
Whereas by the provisions of the “Nuisances Removal and Diseases Pre-
vention Act, 1848,” for the prevention of epidemic and contagious diseases,
and by virtue of an Order of His Excellency the Lord Lieutenant and Pnvv
Council, bearing date the 4th day of October, 1848, directing that the said
jirovisions of the said Act be put in force throughout the whole of Ireland,
IVe the Commissioners of Health are authorized to issue such directions and
regulations as We shall think fit for the prevention (as far as possible) or
mitigation of epidemic, or contagious diseases :
Now in exercise of the authority vested in us as aforesaid. We the Com-
missioners of Health do issue the following directions and regulations: —
1 — We direct all Councils, and other Governing Bodies of Cities and
Boroughs, Commissioners under Local Acts, Officers of Health, Trustees,
County Surveyors, and others by law intrusted with the care and manage-
ment of the streets, and other public ways, and places, to cause at least once
in every 24 hours to be effectually cleansed, all streets, rows, lanes, courts,
alleys, and passages, and public ways and places, under their respective care
and management, and to cause to be removed all filth, and nuisances therefrom.
2. — And further, where it shall appear that there is not any Council or
Governing Bod}', or that by want or neglect of the Council of any City, or
Borough, Commissioners, Surveyors, Trustees, Officers of Health, or others
intrusted with the care and management as aforesaid, of streets and other
public ways and places, or by reason of poverty of the occupiers of premises
or otherwise, there may be any default or delay in the cleansing of, or re-
moving nuisances from any street, row, lane, court, alley, passage, or })ublic
way or other place within any Union, We authorize and require the Guar-
dians of such Union, by themselves or their Officers to cause such street,
row, lane, court, alley, passage, way, or place, to be effectually cleansed,
and all nuisances to be removed therefrom, and to do all acts, matters, and
things necessary for that purpose.
3 — We also direct as follows : —
That when, and so often as any dwelling-house in any part or place to '
which these directions and regulations extend, is in such a filthy and un-
wholesome condition as to be a nuisance to, or injurious to the health of any
person, or.
Where upon any premises, or any part or place as aforesaid, there is any
foul and offensive drain, ditch, gutter, privy, cesspool, or ashpit, or any drain, '
ditch, gutter, privy, cesspool, or ashpit, kept or constructed so as to be a
nuisance to or injurious to the health of any person, or.
Where upon any such premises, swine, or any accumulation of dung,
manure, offal, filth, refuse, or other matter or thing, is kept so as to be a
nuisance to, or injurious to the health of any person, or.
Where upon any such promises (being a building used wholly, or in p.art •
as a dwelling-house) or being premises underneath .any such building, any
animal is kept so as to be a nuisance, or injurious to thehe.alth of .any person :
In each of the .above recited cases, ihe owner or occupier, and persons
h.avino’ the care or ordering of such dwelling-house, or of the premises
where°the nuisance or matter injurious to hc.alth m.ay be, shall cleanse, white-
wash, or otherwise purify, as the case may require, such dwelling-house or
building; or .abate or remove the nuis.ancc or matter injurious to hc.alth .as
aforesaid with all reasonable speed after the publication of these our Direc-
On the Eindemics of 1846 to 1850. 75
tions and Ke^ulations, or after the nuisance or matter injurious to health
llQiV©
4 And where it shall appear that extraordinary medical aid is required
for persons attacked or threatened by Cholera, AVe authorize and require the
Guardians of every Union where such medical aid may be required to pro-
vide sufficient medical aid, and, in suitable places, such medicines as may
be required for necessitous persons attacked by Cholera or by its premonitory
symptoms, and to make arrangements for the distribution of notices, stating
the places where aid and medicines shall have been provided.
5 And where it may be found impracticable to insure proper treatment
at their own homes to any of the poorer classes. We authorize and require the
said Guardians, where it shall appear that such accommodation is required,
to provide Jlospitals or suitable rooms or places, capable of accommodating
necessitous cases, to which persons attacked by Cholera, who cannot be pro-
perly treated in their own homes, may be conveyed.
6. And We require the Guardians of the Poor of any Union, in which jt
may be deemed necessary to provide as aforesaid, extraordinary medical aid
for necessitous persons attacked by Cholera remaining in their own homes,
or to provide in addition. Hospitals, or suitable rooms or places capable of
accommodating such necessitous persons as cannot be properly treated at
their homes, to report to us Avithout delay, the measures or arrangements
adopted to carry out the above objects.
7 And in case of death by Cholera, We hereby authorize and require the
last medical attendant upon the person of the deceased, or in case of there
having been no medical attendant, the housekeeper or person present at tlie
death, or in charge of the body, forthwith to notify the fact of the death to
the Board of Guardians of the Union within which such death may have
occurred, or to the Medical Officer of the District appointed by said Board.
8. — And in case the interment of any person deceased cannot be otherwise
provided for. We hereby authorize and require the Guardians of the Poor of
the Union in which the death has occurred, to provide for the speedy inter-
ment of such deceased person.
9 — And We authorize and direct the said Guardians to make arrange-
ments for obtaining daily Lists of persons attacked by Cholera within their
respective TJnions, with the particulars of their cases and treatment, and for
communicating the same daily to the Central Board of Health.
10 — And We hereby authorize and direct the said Guardians, where it
may appear needful, to appoint such additional Medical Officers, and also to
appoint such other Officers as may be required to execute, and superintend
the execution of these Directions and Regulations, and to publish and circu-
late by printed hand bills, or other means, notices of the provisions of the
said Act for the prevention of nuisances, and of our Regulations and Direc-
tions, or of such part of any of them, as it may appear desirable to make'
publicly known.
Given under our hands this Seventh day of December, One Thou-
sand Eight Hundred and Forty-eight.
Pninip CuAMVTON. D. J. Corrigan.
Robert Kane. II. Marsh.
In issuing the above directions, the Commissioners of Health desire to
draw the attention of the various Public Authorities to the three main objects
of the 11th and 12th Victoria, Cap. 123, which are,
1st — The abatement of all nuisances in connexion with houses or propert}',
for the cost of abating which the owners or occupiers are responsible.
2ndly — Ihe abatement of public nxiisances by the cleansinnr of streets,
and ill! public ways and places, and the clearing out and coverlim- of sewers
or drains. °
3rdly — ^^I’hc Medical relief of the Sick Poor labouring under Cholera or
its premonitory symptoms.
These three objects can be most cffiectually and most economically carried
out m many places by the concurrent and mutual c.xertions of the Boards of
7 6 Report of the Commissioners of Health, Ireland,
Guardians, and of tlie other Public Authorities, and in all towns or places
where there are Town Councils, OfUcers of Health, or other Governing or
Public Authorities having the care or management of such towns or places,
the Commissioners of Health recommend that the carrying out of the (irst
two objects should be intrusted to such Public Authorities, leaving to
Boards of Guardians the execution of the third object, viz., the Medical
relief of the Sick Poor.
In regard to the first object, viz., the abatement of all nuisances in con-
nexion with houses of property, for which the owners or occupiers are justly
responsible — this object can be attained with very little expense or delay by
conducting the proceedings for the abatement of such nuisances under the
first and third sections of the Act, which pi’ovide, that upon complaint of any
two or more inhabitant Householders, summary proceedings may be taken before
a Magistrate to compel the owner or occupier to abate such nuisance, and in
event of delay or non-compliance on his part, to impose on him a fine, and to
have the nuisance abated, charging the expense upon such owner or occupier.
The second object, viz., the abatement of public nuisances, the cleansing of
streets, &c., may be most effeclually and economically carried out by the
Town Council, Officers of Health, Local Commissioners, and Public Autho-
rities of the various towns in Ireland, in whom is already vested by previous
Acts of Parliament the police or management of such towns. In places not
provided with local managing bodies, it will, of course, be requisite that the
duties above mentioned shall be performed by the Boards of Guardians of
the Unions in wffiich such place is situate, or by Officers appointed by them.
This arrangement will not only promote economy, but it will enable the
Guardians in very many instances to devote more attention to the third
object, viz., the Medical relief of the Sick Poor who may be afflicted with
Cholera, and in regard to the most effectual mode of carrying out the neces-
sary measures for this object, the Commissioners desire to draw the attention
of the Boards of Guardians to their first notification, (a copy of which is
enclosed,) which contains such general directions as it is hoped will facilitate
the arrangement of the requmed Medical relief, should Cholera make its
appearance. By Order of the Commissioners,
IV. II. Hopuek, Secretary.
Central Board of Health, Dublin, *Wi December, 1848.
Appendix B., No. 3.
Appointment of Medical Officers under 12 Yic. c. 123.
Central Board of Health, 13, Ehj-place,
Dublin, 21th June, 1849.
Representations having reached the Board of Health, that in several in-
stances Boards of Guardians have elected, as Medical attendants in Cholera
cases, persons who are not duly qualified as Practitioners in Medicine or
Surgery, the Board of Health desire to draiv attention to the fourth regula-
tion of tlieir Circular (No. 2.) of Directions, under the 10th Section of the
Nuisances Remov.al and Diseases Prevention Act, which requires “ that suffi-
cient hledical aid” shall be jirovidcd for attendance on such cases, and to
apprize Boards of Guardians, that the Commissioners do not consider this
direction to be complied with unless the attendants so appointed to adminis-
ter “ Medical aid” shall be fully qualified as Practitioners in IMedicine or
Surgery. The Commissioners have, therefore, to ref(uest, that Candidates
for such appointments, or ])orsons already elected, will submit, for the insjiec-
tion of the Board of Guardians, or the Pour Law Inspectors, or Board of
Health, if required, their Diploma in jMedi<;iue or Surgery, as the Bo.ard of
Health do not consider that under the direction referred to, unqualified jicr-
sons arc entitled to receive Salaries, or to be iqipointed as Medical Attendants
to the charge of Districts or Hospitals.
By Order of the Bo.ird,
To the Clerk of the Union, _ W. II. Hopper, Secretary.
Appendix B., No.
On the Eindemics of 1846 to 1850
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Observations,
Result.
Treatment,
including Doses,
and repetitions of
active Medicines
or Stimulants.
How long ill before Admission.
Confinned
Attack,
duration of.
Previous
Diarrhosa (if
any),
duyation of.
Date
of
Admission.
Nature of Locality,
High, Low, Dry,
or Moist, proximity
to Rivers, state of
Drainage.
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Note — The attention of the Medical Officer is requested to the daily transmission Dale, day of_ 1849.
of the Report of Cholera Cases, during the continuance of the epidemic. , , ,. ,
Signature, Medical Officer.
78
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B.e'port of tlie Commissioners of Healthy Ireland,
Note — The attention of the Medical Officer is requested to the daily transmission ’ Date, day of 1849.
of the Report of Cholera Cases, during the continuance of the epidemic.
Signature, Medical Officer.
Appendix B., No. 6.
ScMMAEY of Returns sliowing the Number of Cases of Cholera, and the Number of Deaths, as reported to the Central Board of
Health, that occurred Monthly in the principal Towns in Ireland.
On the Epidemics <^1846 to 1850
79
Dublin ; Printed by Alexander Thom, 87, Abbey-street,
for Her Majesty’s Stationery Office.
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